Claims Analyst Resume Samples
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Claims Analyst Resume Samples
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Otha
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57718 Brant Locks
Phoenix
AZ
+1 (555) 330 8779
57718 Brant Locks
Phoenix
AZ
Phone
p
+1 (555) 330 8779
Experience
Experience
Los Angeles, CA
Claims Analyst
Los Angeles, CA
Denesik, Kshlerin and Willms
Los Angeles, CA
Claims Analyst
- Provide assistance and ensure transparency in the communication to key internal and external clients e.g., IT, business development, actuarial
- Develop conclusions based on data analysis and make recommendations to management
- Assist management in the development of claim resolution strategies
- Works with Cat Insurance Business Systems to develop claims data interface and management processes
- Researches claims data, performs analysis and makes recommendations on go-forward actions to management
- Assist with administrative work for application preparation
- Provide technical leadership and guidance to the analytics, reporting, and process improvement teams
Dallas, TX
Resolute Claims Analyst
Dallas, TX
Steuber-McGlynn
Dallas, TX
Resolute Claims Analyst
- Demonstrates/models the Network’s Service Excellence Standards of Performance in interactions with all customers (internal and external)
- Familiar with process improvement and project management methodologies
- Provides on-call support after go-live
- Performs additional duties as assigned
- Maintains confidentiality of all materials handled within the Network/Entity as well as the proper release of information
- Complies with Network and departmental policies regarding attendance and dress code
- Proactively completes assigned application deployment, management and testing tasks
present
San Francisco, CA
Senior Claims Analyst
San Francisco, CA
Rosenbaum Inc
present
San Francisco, CA
Senior Claims Analyst
present
- Provide coaching to peers and proactively provide input to improve process and procedures. Performs other duties as assigned
- Develop and execute Construction Claims Service strategies and programs in the NYC Metro
- Directs internal partners and third party service providers in various Risk Management activities
- Assists with policy management and the collection/compilation of renewal data
- Assists management with HUD audits, as necessary
- Market and promote construction claims services, management of projects, financial planning, and control
- Interface effectively with clients, coworkers, and others
Education
Education
Bachelor’s Degree in Accuracy
Bachelor’s Degree in Accuracy
Colorado State University
Bachelor’s Degree in Accuracy
Skills
Skills
- Advanced Knowledge of healthcare delivery Strong functional knowledge and broad multifunctional knowledge of healthcare delivery
- Excellent ability to build and maintain business relationship with clients by providing professional and accurate service
- In addition to other lines, knowledgeable of liability and worker's compensation claims processes and best practices
- Demonstrated ability using all Microsoft applications, including strong keyboard and navigation skills, and capability to learn new programs
- Excellent customer service skills with the ability to diffuse difficult customer challenges and possess excellent problem solving skills
- General knowledge of the Cat Inc. warranty related systems for registration, claims and quality & reliability (is assigned to ESC)
- Ability to work under pressure; ability to work proficiently and efficiently in a timely manner
- 3-5 years professional experience in (re)insurance, with solid knowledge/subject matter expertise in claims administration
- Excellent communication skills & attention to detail
- Advanced knowledge of and the ability to recommend and implement claims policies and procedures
15 Claims Analyst resume templates
Read our complete resume writing guides
1
Claims Analyst, Bodily Injury Resume Examples & Samples
- Investigates claims regarding liability, injuries and other accident related damages promptly
- Establishes and maintains adequate case reserves by adhering to the BI reserving protocol and practices; complies with all established protocols regarding identification, notification and reporting to Major Claims; complies with all established protocols respecting claims settlement authority
- Collects and documents claims related information in a clear and concise manner while adhering to established protocols to ensure accuracy and quality of information
- Establishes and maintains proactive and sound litigated claims file handling by adhering to established guidelines
- Manage both potential indemnity and expense to ensure sound cost management principles and practices
- Exercise sound judgment in the evaluation and resolution of all meritorious claims considering all available information adhering to established guidelines
- Makes prompt contact (in person where practical) with all unrepresented claimants to establish and maintain a relationship of trust and cooperation in order to resolve claims of minor to moderate complexity in a timely manner through a fair and proactive process
- Manages expectations of claimants throughout the claims process by maintaining regular follow up contact, and delivering on commitments made to resolve claims in a timely manner and fair process
- Communicates with clients, third party claimants, witnesses, health care professionals, law enforcement personnel and forensic experts with respect to their role, rights and responsibilities in the claim process in order to establish and maintain their cooperation and / or collaboration
- Build trust and business relationships with Plaintiff Counsel to resolve claims files in a timely manner through a fair, reasonable and professional manner through good communication
- Proactive management and collaboration with Defence Counsel in partnership around all established claims handling and best practices
- Complete all required reports and all notepad entries in a timely manner
- Generally works inside the office environment; are expected to attend out of office settlement meetings, mediations and trials. In person visits are also expected
- Occasional or frequent overnight travel, daily travel to other locations. Some travel required outside of business hours
- May be required to work irregular hours to schedule activities around availability of key contacts or events
- Driving and travel as required
2
Claims Analyst Resume Examples & Samples
- Highly adaptable to an ever changing environment
- Knowledge of PC functions in a Windows based environment
- Excellent communication skills & attention to detail
- Ability to work in a very goal oriented environment
- Claims background
- Fraud background
3
Claims Analyst, Bodily Injury Resume Examples & Samples
- Investigates complex claims regarding liability, injuries and other accident related damages promptly and thoroughly by pursuing investigation to logical conclusion
- Exercise sound judgment in the evaluation and resolution of complex meritorious claims considering all available information adhering to established guidelines
- Makes prompt contact (in person where practical) with all unrepresented claimants to established and maintain a relationship of trust and cooperation in order to resolve claims of high complexity in a timely manner through a fair and proactive process
- Manages expectations of claimants throughout the claims process by maintaining regular follow up contact and delivering on commitments made to resolve claims in a timely manner and fair process
- Generally works inside the office environment; are expected to attend out of the office settlement meetings, mediations and trials. In persons visits are also expected
- Driving and travel as required. May include occasional or frequent overnight travel and daily travel to other locations
- Demonstrate strong leadership and provide coaching, mentoring and training more junior analysts
4
Claims Analyst Resume Examples & Samples
- Prior experience in the healthcare industry
- Claims processing experience
- Proficient in Microsoft Suite
- Managed care and/or delegated group experience
- Prior analytical work
- Ability to read contracts
5
Claims Analyst Resume Examples & Samples
- Experience using DOFR
- Medical record coding experience
- Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) preferred
6
Senior Claims Analyst Resume Examples & Samples
- Manage client relationships by providing and updating the client on status of information needed. Request and evaluate medical information. Manage the information as it is received. Communicate with clients, advisors and other parties regarding the handling of the claim. Handle claim referrals from team members and assists other analysts with complex claims as necessary
- Within designated authority level, adjudicate timely claim payments by determining the type and amount of the claim, verifying in-force status of the insurance policy, confirming policy provisions and determining the appropriate payee of the benefits
- Coordinate investigative efforts ensuring appropriateness of referral of claims to internal resources and outside vendors. Provide thorough review of contested claims
- Actively manage claim reserves throughout the claim process
- Understand regulatory requirements both legal and compliance related to contracts and insurance claims in general
- Utilize referral resources and vendors appropriately to manage claim costs throughout the life of the claim. Performs other duties as assigned
- Demonstrated problem solving and negotiation skills
- College or equivalent with 3+ years of experience
7
Claims Analyst Resume Examples & Samples
- Education/ Training
- HS Diploma, some college preferred
- 3 plus year claims resolution and collection experience, preferably in the apparel industry
- Clear understanding of basic Accounting terms, practices and concepts is required
- Strong verbal and written communication skills are necessary
- Intermediate knowledge of MS Office Excel, Word and Outlook is required
- Basic knowledge of the Internet and web browser is required
- Data entry experience on personal computers and mainframe
- Sense of urgency and ability to work under pressure
- Able to communicate professionally and effectively in both written and verbal forms
- Completes administrative tasks accurately and in a timely manner
- Develop effective strategies to achieve organizational goals
- Ability to multi-task and prioritize workload independently
8
Senior Claims Analyst Resume Examples & Samples
- Manage client and advisor relationships over the course of the life insurance settlement
- Determine settlement requirements
- Request and evaluate medical information as required on contestable life claims. Manage the information as it is received
- Handle claim referrals from team members and assist other analysts with complex claims as necessary
- Provide thorough review of contestable, foreign and complex claims
- Understand regulatory requirements related to contracts and insurance claims in general
- Utilize referral resources and vendors appropriately to manage claim costs throughout the life of the claim. Within approval limits, provide peer review and approvals
- Provide coaching to peers and proactively provide input to improve process and procedures. Performs other duties as assigned
- Understanding of life insurance terminology and life claim settlement practices
9
Claims Analyst Resume Examples & Samples
- Obtain deduction detail and back-up from specific customers
- Investigate unknown deductions by calling customer AP depts./Vendor Relations
- Negotiate deductions and settlements as needed
- Work closely with sales, customer service, shipping, VAS to resolve deductions
- Reconcile deduction information obtained to determine if credit needs to be issued or if the deduction should be denied and collected back from the customer
- Must keep DDO and DDNAO within specific targets
- Communicate effectively and asservitely with customers, both internal and external
- Follow up, Organizational; Negotiation, Communication, and strong Analytical/problem solving skills are all crucial factors for success in this position. In addition excellent written and verbal skills are required. Strong sense of urgency
- Associates degree in Business Management or Business Administration or related degree. Applicable experience will be considered over degree
10
Claims Analyst Resume Examples & Samples
- Validation of marketing and pricing claims and deductions
- Business partnering with cross functions including external customers, Regional Sales and
- Marketing, Finance and Supply Chain
11
Claims Analyst Resume Examples & Samples
- All Claims started within five business days of receipt from loss mitigation or foreclosure
- Filing of all investor/insurer claims within required guidelines to reduce exposure to curtailments and/or fines. In 2005, claims paid to Fifth Third totaled approximately $30.0 million
- Track all claims monthly for status update and/or proceeds
- All claims proceeds posted per investor/insurer requirements within 48 hours of receipt includes posting principal, interest, escrow, other advances, buydown funds, unapplied funds, up to $1 million per week
- Close out accounts to ensure all balances equal to zero through chargeoff and correct the appropriate MortgageServ system settings
- Work with attorney network to ensure evictions, redemption, title issues, mobile home issues, conveyances and reconveyances are handled with due diligence to reduce exposure to curtailments and/or fines
- Work with property preservation vendor, hazard claim vendor, claims outsourcing vendor, city officials, etc. to ensure that the properties are being maintained to investor/insurer requirements
- Math skills
- 0-2 years mortgage default or mortgage servicing related experience
- Prior PC experience to include advanced Excel, Word and Access
12
Claims Analyst Resume Examples & Samples
- Adjudicate claims promptly and effectively in a professional and empathetic manner
- Approve legitimate claims within prescribed authority limits and Service Level Agreements
- Deny claims or rescind policies when required based on contractual definitions, limitations and exclusions
- Approve disability payments based on diagnosis, treatment, restrictions and limitations and occupation
- Material misrepresentation, innocent and fraudulent
- Rescinding insurance coverage
- Disability case management
- Accidental death
- Contractual medical diagnosis vs clinical diagnosis
- Executors of estates and letters of administration
13
Senior Liability Claims Analyst Resume Examples & Samples
- Interacts with TWC employees and business partners, the public, local defense counsel, external insurance representatives, and TWC’s Third Party Administrator (TPA) in the investigation and resolution of liability claims within a predetermined amount of monetary authority
- Researches, resolves and responds to verbal or written requests from insurance carriers, defense counsel, employees and TWC business partners
- Directs the TPA adjusters on the use of cost-containment measures such as the retention of experts, subrogation, etc
- Participates in periodic and ongoing claim reviews and audits to ensure that the claim file is reserved appropriately and that the TPA has implemented an aggressive action plan to resolve each claim in a timely and cost effective manner
- Assists with training of TWC personnel throughout the organization
- Candidate must have 11 - 15 years of experience in managing Auto and/or General Liability claims for a Third Party Administrator (TPA), insurance carrier or within a corporate environment
- Broad knowledge terminology across multiple jurisdictions as it relates to liability claims; grasp of basic liability principles
- Must be able to handle sensitive and confidential information appropriately
- Proven track record managing multiple projects/initiatives independently
- Ability to follow through on assigned tasks with limited supervision
- Attention to detail and ability to edit and proofread effectively
- Ability to build internal and external collaborative relationships and work as part of a team
- AIC, ARM or other equivalent designation
- Bachelor’s degree (B. A.) from a four-year college or university or equivalent training, education and experience
14
Claims Analyst Resume Examples & Samples
- 3 or more years MTV claims processing experience
- Ability to analyze and use data to make decisions
- Project and testing experience
- Ability to review and create reports
15
Claims Analyst Resume Examples & Samples
- Research and resolve wholesale customer disputes and claim charges for all divisions to final disposition
- 3+ years’ accounts receivable, claims resolution and collection experience, preferably in the apparel industry
- Attention to detail with accuracy; Sense of urgency and ability to work under pressure
16
Claims Analyst Resume Examples & Samples
- Analyzing, adjudicating and managing Life and Disability claims taking into account contractual provisions, medical history and all other pertinent information, to determine eligibility for benefits
- Approving disability payment periods based on medical evidence
- Communicating effectively with customers,physicians, lawyers and branches verbally and in writing
- Handling phone inquires/complaints promptly
- Meeting or exceeding all service and quality objective
- Deny claims or rescind policies when required based on contractual definitions, limitations and exclusion
17
Claims Analyst Resume Examples & Samples
- Prior experience working within the Health Service Industry
- Intermediate knowledge of Microsoft Word, Excel and PowerPoint
- Intermediate knowledge of Access database reporting
- Knowledge of SQL
- Strong analysis background
- Experience in a medical claims environment
- Prior testing experience
- Bachelor’s Degree in Business Administration or a related field
18
Professional Claims Analyst Resume Examples & Samples
- Analyzes insurance and matured endowment claims to ensure compliance with organizational and government guidelines
- Maintains an ongoing effort to determine and maintain equity with current claims trends
- Conducts analysis of current claims trends and investigates means to improve claim processes. Recommends improvements and implements same as approved
- Researches and investigates claims systems to evaluate potential impact to organization. Recommends adjustments or changes to systems as appropriate
- Analyzes claims financial reporting practices and reconciliation for client companies. Identifies issues and recommends alternative courses of action
- Informs management of potential liabilities or process improvements related to current claims practices
- Bachelor's degree in insurance, business administration or related field preferred
- Two or more years of claims experience
- Experience working with Lotus Notes, Vantage, DRPS, Life 70, Keymaster and CK4
- Experience with investigating internal claims practices
- Experience working with appropriate claims processing procedures and documentation, and administrative procedures, legislative requirements, and medical principles as they related to examination and approval of life and disability insurance claims
- Strong interpersonal skills to interact with team members
- Strong communication skills to communicate with clients
- Good human relations skills to provide leadership and work guidance to less experienced personnel
19
Senior Claims Analyst Resume Examples & Samples
- Lead a team in the analysis or preparation of a complex construction claims, being responsible for the deliverable to the client, whether it be a report, presentation, or expert testimony
- Management experience, along with extensive experience in Project Controls, CPM scheduling, delay analysis, productivity analysis, claims, and dispute resolution
- Experience with Heavy Highway, transit or building construction, and a strong construction background on large, complex projects is highly preferred
- Establish and maintain professional business relations with clients
- 8+ years of construction claims experience
20
Claims Analyst Resume Examples & Samples
- This position is in a fast-paced, high volume environment with set production goals
- Personal computer operation with skills in various software applications such as word processing, spreadsheet, electronic mail and presentation
- Strong organizational skills, attention to detail with high degree of accuracy, and the ability to work somewhat independently
- Life Insurance experience
21
STD Claims Analyst Resume Examples & Samples
- Makes sound decisions at the time of initial adjudication
- Develops file that demonstrates appropriate decision was made based on documentation
- Develops appropriate business relationship with claimant and the employer. Initiates constant communication with the claimant and employer throughout the life-cycle of the claim
- Reviews and determines continuing claim liability, which includes evaluating and obtaining claim documentation, resolving questions, and determining any changes in status or benefits
- Determine financial liability based on salary, other income sources and contract language. Approve initial payment and determine qualification of continuing payments. Benefit periods can be from 13 - 104 weeks
- Communicates any change in liability or claim status to claimants, policyholders, and appropriate Home Office departments
- Provides various reports to policyholders per contract requirements
- Determine eligibility based on contract language, payroll records, and other supporting documentation
- Demonstrates flexibility and ability to support unique customer requirements
- Knowledge of disability claims procedures
- Knowledge of disability and group insurance
- Strong knowledge of medical terminology
- Analytical and decision-making skills
- Proficient with personal computer and Microsoft applications
- Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations
- Short-term disability claim processing experience (2 or more years required)
- Ability to recognize when to escalate an issue
- Excellent organizational skills, attention to detail with a high degree of accuracy, and the ability to work somewhat independently and apply a sense of urgency
- Proven leadership and/or mentoring experience
22
Claims Analyst Resume Examples & Samples
- Investigate, analyze and respond to complaints from the following sources: Consumer Protection Agencies, Regulatory Agencies, letters of intent/demand letters from Attorneys, claims addressed to Upper Management, claims forwarded to the Corporate Offices
- Investigate liability complaints against First American and/or independent contractors dispatched by First American
- Represent the Company in Small Claims Cases
- Basic mechanical, technical and contract knowledge and understanding (expected to increase with time)
- Possess analytical and investigative skills
23
Claims Analyst Resume Examples & Samples
- Associate degree or equivalent education in any business or communication related field required. Bachelor degree preferred
- Ability to recognize, prioritize, and perform required activities with minimal supervision required
- Must be detail-conscious, organized, responsible, and dependable
- Ability to handle a variety of tasks with an appropriate sense of urgency required
- Excellent interpersonal and communication skills required, with the ability to function independently as well as in a team environment with both internal and external customers
- Keyboarding, Windows, Word, and Excel proficiency required
- Must be able to consider all inputs in making sound decisions in choosing a course of action
- Must be willing and able to assume additional duties, responsibilities, and assignments as needed
24
Claims Analyst Resume Examples & Samples
- Approving disability payment periods based on medical evidence, treatment, restrictions and limitations
- Communicating effectively with customers, physicians, lawyers, and branches verbally and in writing
- Meeting or exceeding all service and quality objectives
25
EDI Claims Analyst Resume Examples & Samples
- Knowledge of HIPAA/EDI X12 v5010 healthcare-related file formats including the 820, 834, 835, 837, 270, 271, 276, 277, 278, 999, TA1 and 824 are required
- Proficiency with regulatory requirements associated with HIPAA, CAQH CORE, ICD-10, and the Affordable Care Act,
- Fluent with commonly used EDI concepts, best practices, and procedures within the health care industry
- Strong verbal and writing communication skills - both technical and non-technical
- Ability to look at the larger picture and understand the interactions of different business and IT teams
- Leadership, communication, interpersonal skills coupled with strong customer driven orientation
- Specific knowledge of claims, enrollment, and premium business processes in a commercial, Medicare, or Medicaid health plan/TPA organization
- Familiarity with Quality Assurance concepts and test plan development
26
Senior Business Claims Analyst Resume Examples & Samples
- 3+ years of experience in business / finance and data analysis
- 3+ years of experience gathering requirements from the client / business and documenting
- 3+ years of experience in claims operations and claims experience (fully understand how claims are paid and various aspects of claims)
- 2+ years Claims processing platform experience, (i.e., CSP Facets, Unet, Cosmos)
- Network Management background
- Clinical background or experience working with clinical is desirable
- Coding experience
27
Claims Analyst Resume Examples & Samples
- 2+ years of Health Insurance and Claims Administration experience
- High School Diploma and/or Associate's Degree in a related field
- Experience in Customer Service and Medical Billing
- Knowledge of ICD-9, ICD-10, CPT, HCPCs, Revenue Codes, and Medical Terminology
- Medical Practice Front-end Billing and/or Claims follow-up experience
- Solid analytical, problem solving and troubleshooting skills
- Knowledge of HIPPA Rules and Regulations and Experience with Medicaid and Medicare claims
28
Claims Analyst Resume Examples & Samples
- Serves as the primary claim contact for designated clients as assigned
- Proactively progresses our clients’ claims from first advice to final settlement
- Ensures prompt payment of claims within compliance requirements
- Acts as an advocate for the client and maintains positive relations with Account Handlers, Client Managers, Account Executives and carriers
- Reports claims to carriers
- Provides initial and ongoing advocacy when required, including detailed coverage analysis, interpretation and negotiation of coverage and reserves
- Resolves technical queries and problems
- Notifies and works with sales teams on highly significant cases requiring Claims Manager involvement
- Coordinates the servicing of all accounts in accordance with client requirements and internal professional standards
- Gathers and reviews loss information and prepares claim status reports
- Responds to and advocates on claims, coverage and exposure questions from clients and production teams
- 3+ years claims experience
- High School diploma required; degree preferred
- Knowledge of claim handling processes and procedures
- Understand medical case management and cost containment programs
- Understand company products, services, global network, and industry practices
- Understand the basic process and value basic data analytics and benchmarking
- Ability to communicate technical information orally and in writing
- Ability to analyze and provide concise conclusions
- Handle multiple tasks simultaneously and effectively prioritize to meet deadlines
- Be self-motivated, able to work both independently and within a matrix team structure
29
Claims Analyst Resume Examples & Samples
- Demurrage analysis
- Process demurrage claim
- Update p/l (inform deals desk) - Ensure all income/costs are being captured in the p/l
- Chasers
30
Business Claims Analyst Resume Examples & Samples
- Handle customer injury claims including premise and loss prevention security claims of varying severity; Responsible for all aspects of claim handling including gathering and reviewing key documents/evidence, interviewing witnesses, drafting correspondence, negotiating resolution, and managing the documentation of all work in our claim system
- Investigate and respond to cease and desist letters, primarily intellectual property business matters
- Provide litigation support for attorneys on litigated files, including consumer class actions, trademark/copyright lawsuits, and bank related actions; Responsibilities include identifying and interviewing witnesses and gathering documents, reviewing and responding to discovery requests, and maintaining an updated central litigation file of notes, documents, and key dates
- Advise on vendor payment disputes and collection efforts
- Assist with product recalls, including gathering sales information, communicating with customer, vendors, the CPSC and Health Canada
- Investigate and respond to customer-related agency charges, including Better Business Bureau and Attorney General complaints
- Respond to third party subpoenas
- Some legal research and work on long-term projects as requested
31
Seasonal Claims Analyst Resume Examples & Samples
- Evaluates/processes Travel Bonus rebates, Buyers claims, wholesale claims and cash back rebates for Affinion products. Enters member and rebate information into Travel bonus system/GRS system
- Performs back up responsibilities for evaluating/processing GRS claims
- Handles bonus/claim/rebate customer service calls and escalated calls. Provides program specific information to members and agents. Handles member inquiries regarding fulfillment, processing and status of claims/rebates
- Performs daily audits of all bonus, claims and rebates to ensure accuracy. Document audit results and corrects errors
- Performs follow up inquiries and makes necessary call backs
- Assist supervisor with the completion and documentation of processes and procedures
- Performs filing and documentation functions
- Handles backline service support as needed
32
Claims Analyst Resume Examples & Samples
- 2-3 years physician/medical billing experience, specifically with charge entry, claims processing and third party payor reimbursement
- Working knowledge of CPT, HCPCs and ICD-10 coding; Medical billing or coding certificate preferred
- EMR/EHR experience required
- Detail oriented and demonstrates high quality work product
- Analyze and verify claim details submitted, check for conflicts, errors or billing inconsistencies and submit all claims for payment. Maintain all related claims submission reports
- Monitor claim status and resolve claim edits, rejected and denied claims
- Processes account adjustments when applicable, including reviewing and resolving edits created by internal billing system and electronic transfer
- Prepare and generate invoice, paper claims and billing statements
- Ensures pertinent information relating to patient accounts and/or payer interaction is documented in billing system
- Communicates effectively, both verbally and in writing, to third party payors, government agencies, MSO staff and other internal departments
- Monitor and process unapplied credits and overpayments within the system in a timely manner
33
Claims Analyst Resume Examples & Samples
- Creates or reviews complex claims disputes large projects
- Researches claims data, performs analysis and makes recommendations on go-forward actions to management
- Reads Project Diaries and Assign CPM Codes to Contractors Activities
- Correlates and Organize Project Documentation Data
- Read and Understand Construction Plans and Documents
- Perform complex claims analysis with minimal supervision
- Draft Reports of Claims Analysis for management review
- LI-NF
34
Senior Claims Analyst Resume Examples & Samples
- Oversees property claim documentation and supports Risk Management staff in handling other claim types
- Assists in the evaluation of claim reserves and settlement requests, providing support information and recommendations to the VP Risk Management for authorization decisions
- Directs internal partners and third party service providers in various Risk Management activities
- Prepares monthly and quarterly Risk Management status reports as well as ad hoc loss runs and other claim data analyses from the TPA’s system, company information and other sources
- Supports Risk Management in department-related research and projects as requested
- Minimum 5 years’ experience in a large, multi-location corporation, with at least 2 years’ experience in a Risk Management department
- Claims experience with emphasis on workers compensation management required
- Ability to effectively prioritize, organize, and perform multiple tasks with varying deadlines
- Workers Compensation Claims Administration Certified (or designation in-process) preferred
35
LTD Claims Analyst Resume Examples & Samples
- Communication with other areas of underwriting, sales and special investigations may also be necessary. The claims must be managed while ensuring customer satisfaction
- Determine eligibility based on contract language, payroll records, and other supporitng documentation
- Determine financial liability based on salary, other income sources and contract language. Approve initial payment and determine qualification of continuing payments
- Adhere to ERISA and other federal/state law concerning group disability insurance
- Creates written letters to the claimant for the purpose of providing concise explanations for claims determinations
- Experience with the application of policies, practices, and procedures in a business environment
- Some knowledge/skill in presentation, electronic mail, data entry, plus PC knowledge to include various software packages, e.g. Word, Excel
- Strong organizational skills, attention to detail with a high degree of accuracy, and the ability to work somewhat independently and apply a sense of urgency
- Good analytical and decision-making skills
36
Claims Analyst Intern Resume Examples & Samples
- Research and support revenue related deduction disputes and post audits from customers
- Assist in account analysis, reconciliation and reporting at month-end
- Assist with internal and external financial audits and reviews
- Prepare ad hoc analyses and participation in special projects as needed
- Review of customer contracts and procedures for revenue deduction programs to ensure compliance
37
Claims Analyst Resume Examples & Samples
- Investigate, analyze and respond to complaints from the following sources: Consumer Protection Agencies, Regulatory Agencies, letters of intent/demand letters from Attorneys, claims addressed to Upper Management, claims forwarded to the Corporate Offices
- Investigate liability complaints against First American and/or independent contractors dispatched by First American
- Represent the Company in Small Claims Cases
- Excellent communication skills (Oral and written)
- Basic mechanical, technical and contract knowledge and understanding (expected to increase with time)
- Exceptional customer service skills
- Possess analytical and investigative skills
- Proficient in Microsoft Word, Outlook and ability to navigate through Access
- Fundamental understanding of the home warranty industry
- Ability to keep composure in hostile conversations
- Bachelors Degree or commensurate work experience
- 1-2 years of previous customer service experience
- Previous leadership experience desired but not required (experience could be work related, school or extracurricular activities related)
38
Claims Analyst Resume Examples & Samples
- Analyzes referrals and claims information for accuracy according to established guidelines and provides education/feedback and reports as applicable
- Assists Claims Auditor with tracing sources of inaccuracies; reports and proposes remedial action to appropriate manager
- Prepares detailed analysis of claims activity and submits reports/findings as requested
- Carries out and maintains records of special processing payment adjustments/check requested
- Works with Finance Department and others as resource regarding all aspects of Outside Medical Claims; researches and provides reports as requested
- Reviews processing of outside medical payments on a continuous basis
- Ensures safeguarding of assets through the verification of documentation, approvals and accurate coding of provider service and accounting data
- Monitors and coordinates special transactions such as check adjustments and credits
- Formats and prepares statistical reports and works close with CAD and local Finance Department to assist with budget monitoring and to assist with financial analysis activities
- Reviews and recommends accurate recording of outside medical utilization data by testing for appropriate and consistent invoice coding
- Performs special comprehensive reports as indicated or requested by management
- Minimum two (2) years of claims analysis and medical billing experience
- Bachelor's degree in accounting, audit, finance or management
39
LTD Claims Analyst Resume Examples & Samples
- This position requires extensive or prolonged typing/keyboarding and phone communication
- Ability to travel and assist in sales presentations when necessary
- Experience in insurance, investigation, research, LTD claim processing or financial reconciliation
40
Claims Analyst Resume Examples & Samples
- Must have experience in Project Controls, CPM scheduling, delay analysis, productivity analysis, claims, and dispute resolution
- An intuitive knowledge and ability to quickly understand principals of construction and contractor means and methods is necessary
- Exceptional written and verbal communications and organizational skills are a must
- The successful candidate must interface effectively with clients, coworkers, and others
- A Bachelor of Science in Construction Management, Civil/Mechanical/Electrical Engineering, Architecture or related degree is required
41
Claims Analyst Resume Examples & Samples
- Initial intake, review and submission of all General Liability and Property Damage claims
- Maintain General Liability and Property Damage claim database
- Maintain Litigated claim database
- Assist in coordination of funding for repairs with Property Management and Construction department for damage claims where outside monies are expected to be reimbursed
- Review, document and analyze financial reserving on all claims
- Review and analyze lease terms on all claims
- Provide direction & interpretation on coverage and lease terms & make recommendations on all newly submitted claims
- Maintain active diary system for frequent and routine follow up on existing files
- Directly pursue financial recovery on property damage claims below deductible
- Document all information and status updates on claims in Risk Management Information System
- Discuss maintenance and property condition issues with Property Management and Construction when premise condition appears to be root cause of incident
- Ensure carrier and/or TPA’s active review of claims with routine follow up and status requests
- Recommend & select specific carrier adjusters authorized to handle the account
- Oversee claim conference calls with insurance carrier and insurance broker
- Main contact, both internal and external, for claim related issues
- Co-Lead claim and litigation routine meetings with the General Counsel of Real Estate
- Pursue appropriate deferment on cases where company is not contractually obligated to indemnify
- Ensure that insurance carrier keeps focus on disposition of cases, reserve accountability, appropriate contract interpretation and legal exposures to company
- Strong communication skills: written, verbal and listening
- Financial analysis skills [insurance cost allocation]
- Prior experience with RMIS systems
- Above Average computer skills including Microsoft Word, Excel and Outlook
- Professional work ethic and demeanor
- Detail-oriented in order to complete work accurately and timely
- Must have commercial property/liability insurance experience
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Project Claims Analyst Resume Examples & Samples
- Must have experience in analysis or preparation of a complex construction claims, being responsible for the deliverable to the client, whether it be a report, presentation, or expert testimony
- Earned Value analysis and trending, construction contracting, planning, staffing, budget management, and resource allocation required
- Market and promote construction claims services, management of projects, financial planning, and control
- 5+ years of construction claims experience
- Previous success developing new business
- Knowledge and ability to quickly understand principals of construction and contractor means and methods is required
43
Claims Analyst Resume Examples & Samples
- Bachelor's degree with 1+ years of experience preferred, or a high school diploma or equivalent with 3+ years of related work experience
- Ability to actively listen while you gather information on the telephone and provide excellent customer service skills
- Excellent analytical, organizational, problem solving, decision-making, and multi-tasking skills
- May be required to become an associated person of Princor Financial Services Corporation, which requires fingerprinting, and a full background check
44
Workers Comp Claims Analyst Resume Examples & Samples
- 1+ year of Claims experience
- Workers' Compensation background
- Microsoft Office/Suite proficient (Word, Excel, Outlook, etc.)
- Prior Processing experience in a Claims support role
- Familiarity with Insurance policies, coverage forms and basic coverage analysis
45
STD Claims Analyst Resume Examples & Samples
- Manages assigned caseload of disability claims for Short Term Disability
- Develops plan to address disability obstacles and coordinates with claimants attending physicians, and employers to return people to work
- Coordinates with Life Waiver team when benefits integrate
- Steps in to manage other team members’ work assignments as necessary
- Strong organizational, interpersonal, and written and verbal communication skills
- Strong analytical and conceptual thinking abilities
46
Advanced Claims Analyst Resume Examples & Samples
- Adjudicate life insurance claim payments by determining the type and amount of the claim, verifying in-force status of the insurance policy, confirming policy provisions and claim requirements, determining the appropriate beneficiary and processing payments. Work with legal, medical and underwriting to determine benefits available on contestable and other complex claims. Coordinate referrals for additional investigation and/or litigation management
- Manage client and advisor relationships by providing and updating on status of information needed. Request and evaluate medical information. Manage the information as it is received. Communicate with clients, advisors and other parties regarding the handling of the claim. Handle claim referrals from team members and when appropriate provide direction to team members. Review and approve claims that are complex or technically difficult
- Understand and clarify legal, compliance and regulatory requirements related to insurance contracts and claims in general. Stay apprised of changing regulations and updates to insurance law. Provide expertise to business partners and team members regarding required process changes
- Provide coaching and training to team members. Provide feedback to improve processes and procedures. Identify issues and provide direction to proactively address issues. Manage and oversee projects in the insurance claims area
- 3 to 5 years Life Insurance death claim experience
- Excellent communication skills; written, verbal
- Ability to work on and influence a team
- Understanding of life insurance contract law, regulations
- College degree or insurance claims industry experience
- Industry course work such as ICA, LOMA, ALU, CLU, etc. is preferred
47
GAP Claims Analyst Resume Examples & Samples
- Handle initial report of loss and control costs. Investigate and maintain a complete and thoroughly documented claim file
- Conduct timely investigations including recorded statements
- Identify subrogation and/or salvage situations in a timely manner to protect the interests of the Corporation
- Develop subordinates
- Maintain necessary licensing and continuing education
- HS diploma or equivalent required. Associate / Bachelor's degree in business related discipline preferred
- 3 + years in financial services or similar industry is needed. Prior leadership experience is preferred. Education may be used as a proxy for experience
- Perform technical tasks required to support ongoing business operations
- Typically requires advanced knowledge of Microsoft Office Programs
48
Warranty Claims Analyst Resume Examples & Samples
- Demonstrate high integrity and compliance with all laws and regulations
- Be focused on long-term value creation
- Possess an entrepreneurial spirit, and prioritize her/his work to focus on the highest-value activities first
- Be comfortable delivering on short time frames and meeting deadlines
- Understand and anticipate customer requirements
- Be open to learning and challenge
- Embrace change and be motivated to identify new opportunities for the company
- Be modest in nature, recognizing the accomplishments of the team before the individual
- Be respectful of others
- At least one year of relevant work experience in customer service
- At least one year of relevant work experience in insurance or warranty claims
49
Claims Analyst Resume Examples & Samples
- Acts as Claims Department subject matter expert on departmental and corporate projects. Supports business definition and testing efforts, attends project meetings, and provides internal and external status reports
- Works with management and associates to document current business and workflow processes and collaborates in identifying, defining and documenting process improvement options and alternatives
- Prepares detail and summary level reports including written interpretation of analytic results for senior management
- Analyzes and trends claims issues, performs true root cause analysis and determines next steps for resolution and process improvement
- Researches issues, compiles feedback and drafts corresponding business requirements documents and business decision documents as needed
- Participates on conference calls with supervisor/manager/director other departments to provide project status, communicate changes in processes, and issue resolution
- Communicates test findings in a structured report format
- Build strong cross functional relationships that can be leveraged to understand issues that would not be in the sample size
- Escalate issues when on issue results in multiple discrepancies
- Assist supervisor, manager, and/or director with projects and problem resolution as required
- Runs and analyzes ad-hoc reports
- Formulates and applies analytical reports using the company’s database to develop and interpret information that assists in developing test cases
- Tests validity of data using related software, service, manual calculations, or products. Frequently concentrates on collecting and analyzing data and developing test case scenarios both positive and negative
- Recommends processes or updates to current workflow as a result of research or analysis
- Provides assistance and support as needed to develop training material on new updates and enhancements
- Responsible for special projects that require analytical skills, forward-thinking whereby data is analyzed from different angles to think of the unknown, test the process
- Track and follow-up on all assigned high-level discrepancies, utilizing systems and procedures
- Maintain a high standard of data integrity, including systems and reports
- Preferred A Bachelor's Degree in a related field or equivalent directly related experience
- Preferred 5+ years of experience in practical work within a healthcare organization
- Required 3+ years of experience in claims processing with a solid understanding of internal company claims functions
- Advanced Knowledge of healthcare delivery Strong functional knowledge and broad multifunctional knowledge of healthcare delivery
- Advanced Demonstrated organizational skills Demonstrated organizational skills with the ability to prioritize, coordinate multiple tasks, and work independently
- Advanced Demonstrated problem solving skills
- Advanced Demonstrated written communication skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Advanced Ability to effectively present information and respond to questions from peers and management Strong analytical and problem solving skills
- Preferred Intermediate Microsoft Access
- Required Intermediate Other Knowledge of Perot / Peradigm system
- Required Intermediate Other Thorough knowledge of WellCare claims processing environment and procedures
- Preferred Intermediate Other Knowledge of Legacy and Intelliclaim systems / processes
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Claims Analyst Resume Examples & Samples
- Provides guidance, direction and specialized assistance for the resolution of difficult and complex claims issues
- Works on claims issues of significant risk or impact to the organization requiring advanced knowledge of claims principles
- Presents claims findings in a formal environment
- May oversee claims review
- Performs “what if” analysis
- Research claims data
- Documents and drafts reports of claims analysis findings
- Read Project Diaries and Assign CPM Codes to Contractors Activities
- Correlate, Organize, and Synthesize Project Documentation Data
- Assist management in the development of claim resolution strategies
- Assist in training less experienced staff
- Bachelor's degree in Engineering, Architecture, Construction Mgmt or Business plus 7 years related experience. Without preferred degree, 11 years’ experience in project controls required
- Able to use and Primavera, P6, Microsoft Project or similar planning and schedule analysis tools
- Suitable experience involving construction litigation or alternative dispute resolution matters in lieu of Project Controls experience will be considered
51
Claims Analyst Resume Examples & Samples
- Corresponds through verbal/written communication with policyholders, claimants, travel coordinators, etc. to gather important information to support claim decision
- Serve as a customer advocate in all interactions to provide an outstanding customer experience
- Productivity (Review, assess, and process claims with adhering to established SLAs)
- Solid knowledge of principles and processes for claim examination, evaluation, and disposition
- Strong problem solving and decision making , and active listening skills
- Ability to adjust readily to multiple demands and constituencies, shifting priorities, and rapid change
- Ability to communicate in a clear, concise manner appropriate to the audience via phone, email, and in writing
- Strong computer literacy with demonstrated keyboard skills, solid knowledge of technology used for claims administration, and familiarity with Microsoft office software
- Prior customer service experience, within a claim environment a plus
- Bachelor’s degree or equivalent work experience preferred
52
Claims Analyst / Senior Claims Analyst Resume Examples & Samples
- Reviews, analyzes, evaluates, investigates and determines benefits for larger dollar or more complex claims in accordance with policy provisions and government regulations; exercising limited discretion in the application of rules, and procedures for claim handling
- Initiates payment or denial of claims via the claims system when all claim-related questions are resolved, according to policy provisions
- Communicates with external and internal customers to obtain specific claim information in order to finalize pending claims and to explain claim handling
- Remains abreast of Company and industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures
- May provide various reports to internal and external customers
- Actively participates in the identification and implementation of process improvements
- Maintains frequent written and verbal communication with the claimant and employer during the duration of the claim
- Communicates via telephone with claimant, employer and other appropriate parties
- Ability to meet deadlines under pressure
- Good analytical and decision making skills
- Experience as a Claim Analyst or other claims environment
- Accident claims experience
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Claims Analyst Resume Examples & Samples
- Use technical skills to develop reporting tools and applications to support business objectives
- Provide consultative services to the claims department to thoroughly understand their needs and translate those needs into technical solutions
- Provide analytical support for various ad hoc reporting and claim support activities
- Look for ways to improve efficiencies and minimize processing and workflow issues
- Provide technical leadership and guidance to the analytics, reporting, and process improvement teams
- Maintain understanding of departmental service standards and guidelines, systems, workflows, reports, products, and other information needed to complete work assignments
- Intermediate expertise in VBA, SQL, Access and Excel. The top candidates will complete online testing for skill proficiency
- Strong written and oral communication skills, including the ability to ask the right questions to fully understand business needs and to communicate technical information in a business friendly manner
- Flexibility in adapting to rapidly changing technical environment
- Exceptional analytical and problem solving skills and creativity in developing business solutions
- Self-motivated and able to work with a high degree of independence
54
GAP Claims Analyst Resume Examples & Samples
- Handle initial report of loss, explains claim process, coverage, and follows up for necessary documents to conclusion of the claim
- Investigate and maintain a complete and thoroughly documented claim file
- Handle inquiries from retail customers, financial institutions, and dealers
- Review finance documents and ancillary products/refund amounts to determine outstanding balance owed on the date of loss
- Review insurance company valuation (CCC, Mitchell, Audatex, NADA, Market Research, etc.), settlement breakdown, and declaration page to confirm or ensure that the primary insurance carrier paid/pays their liability
- May handle special projects
- Computer literate with experience with Microsoft products (Outlook, Word and Excel)
- Strong data entry/typing skills
- Must be able to handle up to 20-30 calls per day
- Insurance license preferred
- Call Center, Auto Finance, or Insurance experience preferred
- Bilingual (Spanish/English) a plus
- Must be able to successfully pass a pre-employment drug screen and a comprehensive background check
- Must be authorized to work in the U.S
55
Field Claims Analyst Resume Examples & Samples
- Delivers continuously improving year on year expense results by improving processes and increasing productivity
- Supports rigorous quality, control and compliance programs to include an ongoing control/compliance self-assessment process
- Basic knowledge of general/standard office and administrative procedures and methods
56
Salvage Claims Analyst Resume Examples & Samples
- The Analyst will determine when and who to bill, provide actual cash value for vehicle and what documents need to be sent with the letter on initial billings for US subrogation files. The Analyst will be responsible for maintaining an accurate pending eSalvage current and backlog count; and other duties as assigned by the Supervisor
- Review Legal Holds on a timely basis to ensure releases are processed timely and accurately; and in accordance with Risk Management guidelines
- Handle salvage calls from customers, insurers, or Hertz locations to determine if information needs to be appended to an existing file, referred to HCM, or a new file opened. If new, all information is to be documented in a pre-established form
- Initiate billing process providing actual cash value or estimated value of unit less sale proceeds to bill at fault party
- On all unmatched salvage claims but no VDA, follow-up with the return location for submission of the VDA
- Meet all quality standards and expectations per Best Practices
- Comply with State specific regulations
- 3-5 years Claims Management or Accounts Receivable experience
- Accounts Receivable
- Auto damage appraisal a plus, but not required
- Knowledge of insurance industry relating to auto damage claim recovery preferred
- Superior independent decision making and critical thinking
- Strong task management skills
- Proficient in Microsoft Word and Excel
- Strong Computer/Software skills
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GI Claims Analyst Resume Examples & Samples
- High quantitative affinity and highly developed curiosity
- Very high desire to constantly learn and improve the front end tools to achieve best in class results for the application of the tools
- Conduct sophisticated claims data mining and analytic investigations to spot underlying root causes on behalf of the Claims Analyst
- Work closely with internal and external IT application and platform provider to achieve the most efficient IT set up to ensure high performing and compelling front ends
- Collect data from sources and prepare reports including commentary and an analysis of trends to facilitate decision-making
- Input relevant data into established systems accurately so that analysis can be undertaken
- Knowledge of Claims
- Effective Communications
- Knowledge of Insurance Industry
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Claims Analyst Resume Examples & Samples
- Accurately adjudicate claims in accordance with health plan guidelines, company standards, and company procedures
- Maintain minimum production standards as set by Care1st Maintain a 98% or above financial accuracy rate and a 95% or above procedural accuracy rate
- Review claims for appropriate information and accurate reimbursement
- Prioritize and manage individual workflow as needed
- Maintain completed and updated set of resource materials necessary for processing claims
- Attend all company-mandated training and remain current with knowledge in the claims field
- Assist with data entry of claims as needed
- 3-4 years of claims processing (Commercial experience preferred)
- Knowledge of CPT, HCPC, ICD-9, and Revenue codes, medical terminology, general billing guidelines, pricing, and provider contracts
- Experience in processing claims according to multiple plan guidelines
- Experience with application of deductible, coinsurance, and copayments
- Ability to research and adjudicate CMS-1500 and UB-04 claims of all levels of complexity
- Analytical skills to resolve complex claims
- Strong multi-tasking skills and the ability to identify and trend processing/billing issues
- Must be organized with a positive attitude
- Working knowledge of Microsoft Word, Excel, and Outlook
- Ability to work as a team player in a professional, fast-paced environment
- Able to communicate effectively and tactfully in both oral and written form
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Claims Analyst Resume Examples & Samples
- Manage Workers Compensation claim activity from initial claim notice to claim conclusion; ensure a timely return to work and coordinate all activity with Benefits, Payroll and Human Resources
- Assist the Director of Risk and business teams in the handling of all General Liability, Property, Builders Risk and Auto claims throughout the country
- Manage the activity of the Third Party Administrators and/or adjusters on a daily basis with respects to all claims
- Possess the ability to analyze claims, interpret insurance policies, and direct strategize on the resolution of all claims in coordination with the Legal Department
- Evaluate and authorize claim settlements when provided with a given limit of authority
- Communicate effectively the Legal Department and all business teams on updates, claim information requests, and recommendations
- Review, and track all Incident Reports; follow up for additional information where necessary; make recommendations to the Director of Risk on insurance programs that may be triggered
- Investigate, evaluate and strategize on resolution of non-litigated matters
- Prepare monthly claims reports and identify loss trends
- Assist with loss run review and analysis
- Maintain Workers’ Comp-related OSHA Logs (OSHA 300) for all required business teams on a daily basis and distribute on an annual basis pursuant to OSHA guidelines
- Assist the Director of Risk Management in the day-to-day operations of the Department as necessary
- Bachelor’s degree with emphasis in Risk Management, Business or Finance
- Minimum five or more years of experience in claims management
- Knowledge of a Captive Insurance Company preferred
- Must possess strong organizational and communication skills
- Experience in Outlook, Excel, Microsoft Word, Power Point, Autonomy /i-Manage HP experience is a plus
- Ability to work independently and manage multiple projects simultaneously
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Claims Analyst Resume Examples & Samples
- Bachelor’s Degree in a business related field preferred or the equivalent amount of related experience required
- 2-4 years’ experience in project management, and intermediate experience with analysis of information and data
- Advanced MS Excel skills required. Proficiency with desktop and MS Office applications
- Excellent analytical, organization, and multitasking skills
- Able to work well under pressure and within short deadlines
61
Claims Analyst Co-op-consumer Markets Resume Examples & Samples
- Monitor & report on the results of one or a few initiatives in market, conducting analysis on performance relative to expectations, and making recommendations for enhancements
- Utilize current and emerging data science techniques to manipulate large structured and unstructured data sets, help identify patterns in raw data, and develop models to predict the likelihood of a future outcomes
- Prototype new algorithms in software systems
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Claims Analyst Resume Examples & Samples
- Must be educated in shipping studies to degree level
- FLUENT in English
- Organised, careful, pays attention to detail, able to work in a high-pressured environment, dealing with a range of high priority issues
63
Claims Analyst Resume Examples & Samples
- To handle, book and administer Reinsurance Claims (Treaty Non Proportional & Facultative) out of the India Reinsurance portfolio across all Non-Life Lines of Business
- To perform technical claims administration duties following governing claims guidelines and processes. This includes analyzing, checking and booking of claims received from various brokers and cedants, verifying Treaty/Facultative coverage, handling reserves and settlement of claims, booking of Reinstatement Premiums
- Close cooperation and coordination with Shared Services regarding Proportional Claim Events and Cash Losses, coordination of combined payments, etc
- Co-ordinate and collaborate on complex claims matters with the Reinsurance Claims Manager and support risk and claims data analysis and reporting, including data quality control activities
- Proactive review, reconciliation, processing and adjustment of claims (following internal claims guidelines and processes) - from first loss advice through to loss reserving updates up to claim settlements; for non-proportional treaty and/or facultative reinsurance claims/programs
- Check claim coverage, treaty/risk limits and process/book relevant claims data (incl. reinstatement premiums) reported by clients (brokers or cedants) electronically, assuring accuracy and integrity of the technical claim bookings in proprietary Claims Reinsurance Ledger system
- Verify, prepare and process outgoing claim settlement requests and general claim related administrative requests from clients (brokers or cedants)
- Conduct ad hoc data cleansing/refinement tasks, based on specified data quality control/’housekeeping’ reports
- Investigate inconsistencies, claim/account discrepancies and related issues and raise/resolve these independently or in cooperation with the Reinsurance Claims Manager
- Closely cooperate with the Technical Accounting and/or Shared Services teams in respect of Proportional claims and its payments
- Provide value and insight to the Reinsurance Claims Manager, Underwriters and Actuaries in respect of claims issues, loss reporting and/or large loss information, etc
- Conduct month-end, quarter-end and year-end claim reserves reconciliations, supporting financial closing and reporting processes
- Assist the Reinsurance Claims Manager in the collation of data, respond to queries raised by internal and/or external parties in a confident, timely and accurate manner
- Bachelor degree (or equivalent), preferably in a quantitative discipline (e.g. economics, law, finance or accounting)
- 3-5 years professional experience in (re)insurance, with solid knowledge/subject matter expertise in claims administration
- Analytical approach, diligent and accurate working style, flair for numbers, attention to detail and a meticulous eye for identifying inconsistencies or inaccuracies in claim data entry or claim data outputs
- Comfortable taking ownership for own work, identifying the need for action whilst working effectively within a team. Team player with good communication and interpersonal skills
- Proactive mind-set: able to work independently, demonstrating strong prioritization and time management skills and delivering against tight deadlines. Demonstrates a ‘can do’ attitude
- Knowing what it takes to provide a consistently first class customer service
- Proficient with MS Excel (MS Access optional/would be a plus)
- Solid English language skills (spoken and written)
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Senior Claims Analyst Resume Examples & Samples
- Previous knowledge and experience with medical insurance processing; preferably FSA, QME, PRA claims
- BA/BS Degree preferred and minimum of 3+ years related work experience in a benefits administration or outsourcing environment
- Possess basic understanding of wide variety of benefit issues including health and welfare and retirement
- Able to prioritize and manage multiple competing responsibilities
- Show initiative including anticipating needs, suggesting improvements, and follow-up on work items
- Proficient in Windows and Microsoft programs with excellent navigational skills
- Projects positive, professional attitude
- Detail-oriented and superior organizational skills
- Works independently and with minimal supervision
- Will be trusted to secure and maintain confidential information
65
Senior Claims Analyst Resume Examples & Samples
- Basic understanding of costs and revenue streams associated with tankers trade
- Overview of cargo (oil) operations on ship's side
- Basic understanding of different bunker grades with their usage in different operations with regulatory 4. Good understanding of costs associated with war zone related trading
- Awareness on currency regulations while dealing with invoices associated with embargo nations
- Very good understanding required to grasp key contractual terms (charter party terms) with business intent
- Good at written communication and negotiation skills
- Culturally aligned to the company
- Ability to carry out first level stakeholder management
- A number cruncher
- Ability to continue on a repetitive set of activities
66
Priority Claims Analyst Resume Examples & Samples
- Perform internal and external review of data, files or medical charts to ensure that all required documentation is in compliance with guidelines; such as, CMS and other medical policies
- Prepare assessments based upon facts, document the company’s position, and obtain all documents to support the analysis
- Consult with management, clinicians, physicians and physician staff (if acceptable within the Region), as needed, on documentation issues, clinical deficiencies, new trends, and other regulatory issues potentially require internal policy changes
- Develop and manage relationships with colleagues in a professional manner
- Update tracking and billing systems accordingly
- Attend department meetings and discuss unique audit findings
- Responsible for conducting special projects, which may include reconciling and reviewing medical necessity
- Attention to detail with the ability to quickly identify trends
- Able to communicate well and exhibit good interpersonal skills
- General knowledge of Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), policy articles, and medical terminology
- Self-starter and take the initiative to proactively solve/investigate problem areas
- Personal accountability and able to meet deadlines
- Demonstrates general knowledge of MS Office suite programs
- General knowledge of Electronic Health Record systems; such as, OPS and NextGen
- Demonstrates the ability to pull data, scan, and migrate into OnBase
- Demonstrates high ethical standards regarding confidential patient and billing information; ensuring compliance with relevant laws, including HIPAA requirements, regulations and established Hanger policies and procedures
- Bachelor’s degree is required; 4 years of practical experience in lieu of education is acceptable
- Typically requires less than 1 year of related experience regarding CMS policies and medical policy
- Para-Legal background (preferred)
67
HFP Claims Analyst Resume Examples & Samples
- Conducting investigations and analyzing and evaluating the information learned
- Accurately analyzing and determining coverage, liability and damages based upon the facts of each claim
- Proactively managing caseload including evaluation of overall exposure and identification of potential financial impact to the policy, leading to the development of effective file strategy and sound reserve rationale
- Communicating written position(s) to insured’s and other required parties on coverage, liability, damages and other issues
- Appropriately working with stakeholders including defense counsel, insured’s and co-defendants
- Proactively managing litigation and counsel, inclusive of litigation planning and execution, budgeting and bill review
- Developing and implementing resolution strategies to achieve high quality outcomes
- Ensuring files are appropriately documented
- Presenting cases to management for expense or indemnity reserve authority on appropriate files
- Preparing comprehensive reports to claim leadership on case developments and policy issues, etc
- Participating with others in the preparation for or attendance at mediations
- Providing support to, and working collaboratively with unit members on case specific issues as needed, departmental reporting and/or projects, etc
- Responding appropriately and timely to inquiries/requests for information from all business partners, including agents and policyholders, providing superior customer service
- Bachelor’s degree required; professional designation and/or legal degree a plus
- 1 to 3 years’ experience at a law firm or insurance company highly desired
- Basic knowledge/understanding of financial product lines coverage and liability exposure desired
- Candidate should possess strong analytical skills and be disciplined and results-oriented
- Strong strategic thinking abilities and execution skills
- An ability to communicate thoughts clearly and concisely, and to influence and persuade others
- Superior interpersonal skills, with an ability to work well as part of a team and/or in supporting roles
68
Warranty Claims Analyst Resume Examples & Samples
- Analyze and process engine warranty claims
- Review claim information provided by dealers and, working independently or with Vendor Recovery, Engineering or Quality, process claims per established guidelines
- Provide best in class support to our Fleet Customers and Dealers on a regular basis
- Perform additional technical and administrative duties as assigned
- Serve as a subject matter expert for assigned responsibilities
- Work closely with external/internal stakeholders to understand business challenges and opportunities for improvement
- BS/BA preferred; A.A. required or a minimum of 3 years of truck production, order processing, purchasing, sales administration experience, or diesel mechanic certification required
- 2+ industry related experience preferred
- Ability to create and manage ad-hoc SQL queries within MS Access or Tableau to help support management decision making a plus
- Must have strong communication and negotiation skills; proficiency in MS Word, Excel, PowerPoint and Access; and have good recall of detail and a mechanical aptitude
- Must be self-motivated and able to work in a fast paced just-in-time environment with rapidly changing objectives
- Must be able to accept responsibility for assigned projects and work effectively under general or minimal supervision
- The ideal candidate will have a mechanical or technical aptitude, be comfortable with processing large volumes of data, and be able to provide data driven answers to questions about the material processed
69
Claims Analyst Resume Examples & Samples
- Research customers claims and make decisions to determine if UMG should deny the claim or make a billing adjustment for pricing errors and shipment discrepancies deferring more complex issues to the credit management
- Prepare paperwork for billing adjustments and, if necessary, follow up with correspondence to the customer
- File claims with trucking company for lost or damaged product
- Travel to accounts when necessary to assist Credit staff with reconciliation meetings
- Act as a liaison between junior claims staff and Credit Manager. Give direction to junior staff when necessary
- Assist Credit staff with claims reporting, special projects, return reconciliation and trouble shooting
- Exceptional Problem solving skills
- Computer skills including knowledge of spreadsheet and word processing
- 3 Years claims processing experience within media/entertainment, retail, manufacturing or similar industries with an emphasis on chargebacks and deductions
70
Risk Claims Analyst Resume Examples & Samples
- Work closely with the General Counsel and Risk Manager on litigated matters (status and responses)
- Manage Liability and Workers Compensation claims, including working with TPA’s, Attorney’s and Insurance Companies. Facilitate reports to support reserve increases and settlement approvals for such claims
- Identify loss trends and work closely with the Risk Manager and Director of Safety to assist in mitigate of such trends as necessary
- Collect, analyze and maintain assets schedules as needed for insurance exposure reporting
- Bring to the attention of the Risk Manager any activities related to claims, insurance or contracts that generate concern
- Work closely with Legal, Operations and Insurance Agent to review insurance, certificates and related contract language for the approval or denial of Newpark’s vendors
- Work closely with the Risk Manager in the maintenance and renewal of Newpark’s Global Insurance Program
- Assists with identification and analysis of risk exposures in areas of safety, security, safety, customer/vendor contracts, insurance policies, insurance coverage levels
- Coordinates insurance policy renewals, claims and administration, issuance of insurance certificates and other risk minimization programs
- Assists with reviews of insurance language and indemnification provisions in contracts, leases and agreements to protect company and ensure compliance with contractual requirements
- Provides insurance summaries to business units as needed
- Responds to inquiries regarding insurance programs and premium allocations
- 5 years of experience or equivalent
71
Claims Analyst Resume Examples & Samples
- Ongoing review of insurance coverage and contract language
- Verification and formalizing internal fee allocations and schedules
- Assist with administrative work for application preparation
72
Claims Analyst Resume Examples & Samples
- Ensure correct termination of policy according to the legal documents submitted
- Disbursement of claim values based on the policy complexity and provisions; completeness and validity of documents
- Accurate adjustment and calculation of claim proceeds from life insurance accumulated values
- Assess survivorship death notices for policy riders, update systems and disbursement of proceeds
- Notification of outstanding claim requirements through outbound correspondence
- Deliver precise and comprehensive communication
- Constantly meet and maintain productivity, accuracy and service level standards
- Update pertinent documents, work inventories and trackers
- 4-year College graduate with either of the following courses
- Medical
- Note: Nice to have claims processing experience
- MS Word, MS PowerPoint, MS Excel
- Good communication skills written and oral
- Ability to compose email correspondence
- Alpha numeric: 28 wpm
- Numeric: 33 wpm
- Completion of the compliance training
- Completion of the 4 - 8 weeks training period
- Passed New Hire Skills Verification Exams
- AWD10
- Outlook360
- ELAPS
- Knowledge of company plans/line of business, riders and benefits
- Knowledge of insurance contract law and state legislative requirements
73
Business Risk Management / Claims Analyst Resume Examples & Samples
- Directs claims administrator or insurer for general liability, property, automobile and other types of claims as needed
- Coordinates with the appropriate business unit associates to obtain additional claim information
- Builds, maintains, and manages relationships with claims adjusters, insurers, outside legal counsel, and other claims related parties
- Provides recommendations on settlements and reserves
- Provides monthly reports of activity status and financials
- Identifies claims trends and collaborates on solutions
- Completes required external reporting requirements
- Other duties include bookkeeping entries and claim system reconciliations
- General understanding of property casualty insurance coverage
- 2+ years’ experience directing claims - preferred
- Experience with Risk Management Information Systems and/or web page design a plus
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Claims Analyst Resume Examples & Samples
- Strong interpersonal and communication skills required
- Strong Microsoft Office skills required – thorough knowledge of Excel spreadsheets, PowerPoint presentations and WORD documents required
- Proven track record in providing a positive customer service experience while handling customer and third party claims required
- Experience in dealing with claims adjusters and legal professionals required
- Experience in handling claims within a corporation preferred
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Claims Analyst Resume Examples & Samples
- Complete claims reviews to validate accuracy and validity of client reported claims
- Perform claims administration as required: validating and logging claims files and data, tracking, reviewing and aging of claims
- Produce, analyze and update control reports and escalate any issues with potential or known financial impact
- Analyze and validate reinsurance files and corresponding premium payments. Processing and providing accurate and timely information to internal and external stakeholders in relation to the client data
- Document and follow operations procedures and adhere to SOX process controls
- 1-3 years experience in reviewing/approving insurance claims
- 1-3 years life reinsurance/insurance experience preferred
- Post -secondary education or equivalent with a background in business, mathematics, economics or accounting
- Intermediate to advanced MS Excel skills
- Shows judgment in critically evaluating client data
- Takes responsibility for quality, completeness and accuracy of work
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Quality Claims Analyst Resume Examples & Samples
- Review and evaluate the accuracy of the examiners’ claim decisions. Identify any inconsistent and/or inaccurate benefit and policy usage
- Maintain statistical data tracking quality and production totals. Analyze trends in claims management
- Conduct training needs analysis and work with managers to develop group and/or individualized training to correct developmental and performance issues
- Review and assess claims reporting mechanisms to determine system inaccuracies
- Identify claims-related training needs of other departments and facilitate or assist with training, if needed
- Work on resolving more complex claim issues
77
Tslc Claims Analyst Resume Examples & Samples
- Analyzes medical claims and reviews billing information for correctness and completeness
- Submits data to CMS to ensure compliance with all PACE and Medicare Part D reporting requirements in the Health Plan Management System (HPMS)
- One year experience in claims, claims adjusting or billing experience preferred
- Previous experience in billing preferred
- Familiarity with ICD-9-CM and CPT coding
78
Resolute Claims Analyst Resume Examples & Samples
- Reviews and understands system options and specifications of Applications and utilizes the specifications as applicable to make recommendations on use
- Analyzes design alternatives and makes appropriate design decisions. Designs, validates and confirms new or changed functionality with the application environment that meets customer specifications. Understands and translates the business/department functionality into Application configurations and workflow validations
- Builds, tests, and debugs application to ensure the system meets end-user requirements. Builds complete testing plans to validate system parameters and functionality performs as specified with minimal guidance
- Provides guidance and mentorship to other analysts
- Maintains project documentation including resources used, decisions, outcomes, agreements etc
- Works with vendors as appropriate to ensure smooth operation of products, reporting and resolution of issues
- Supports new project development including system analysis, planning and preparation
- Provides Epic product function, design, and build expertise and experience needed for successful product implementation
- Participates on new implementation / installation project teams
- Supports all project team members with application and information systems knowledge
- Logs, tracks, analyzes, and coordinates system changes including any software code implementations
- Maintains current knowledge of technology by attending appropriate continuing education training/seminars and reading related periodicals
- Maintains confidentiality of all materials handled within the Network/Entity as well as the proper release of information
- Comply with Network and Departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements
79
STD Claims Analyst Resume Examples & Samples
- *This job posting is reflective of the entry level Analyst essential functions, qualifications, and physical requirements. The Sr and Specialist levels have variable essential functions, qualifications and physical requirements. Competency and skill set will determine level of placement within the posted job family
- Develops appropriate business relationship with the claimant and the employer
- Maintains frequent communication with the claimant and employer throughout the life-cycle of the claim
- Communicates via telephone with employers, physicians (or other providers), and claimants
- Communicates any change in liability or claim status to both internal and external customers
- Provides various information to policyholders per contract requirements
- Embraces process improvement and pursues ways to simplify and streamline our operations
- The ability to perform extensive or prolonged typing/keyboarding and telephone usage
- The ability to operate in a fast-paced, high volume environment with set production goals
- Executes daily activities that support our core purpose, what we do and our strategic anchors. Uses the strategic anchors to guide decision-making and prioritization of work
80
Claims Analyst Resume Examples & Samples
- Recording new claims directly onto the AIG system tahat are receives via telephone, ost, fax or emails
- Entering accurate and detailed information into cliam handling platform to generate a claim number
- Creating and sending customers an acknowledgement letter which includes claim number and adjuster contact information
- Taking pro-active stesp to effectively manage customer expectations in order to achieve overall customer service proposition
- Contributing to ensuring the Unit's Key Performance targets are met and that own objectives are achieved
- Ensuring that all allocated wrk is handled within the Key Performance Targets. Department following agreed internal and external processes, policies and procedures to ensure quality and service standards are met
81
Casualty Claims Analyst Resume Examples & Samples
- Approximately 5 years handling commercial casualty claims
- College/University or equivalent industry experience
- Ability to make decisions and give directions to adjusters and/or counsel
- Must be a quick learner with strong communication and negotiating skills
- Proficient computer skills to navigate paperless claim file system
82
Claims Analyst Resume Examples & Samples
- Claims or litigation background
- Employment practices or financial experience is a plus
- Strong written and verbal communication skills
- Strong interpersonal and organizational skills
- Strong computer skills (Microsoft Word and Excel)
83
Claims Analyst Resume Examples & Samples
- If assigned to other than Extended Warranty Claim, acts as the first point of contact when a property damage claim, suit or underlying material is reported. Determines the nature of the loss, coverage provided, and scope of injury and/or damage. After reviewing documents and information related to the loss, directs an investigation, if needed, secures and files all supporting documentation and verifies it for accuracy and completeness. Provides interim claim processing information and final settlement notices
- If assigned to Extended Warranty Claims, establishes regular dialogue and reporting with Caterpillar Inc. product groups and CPI to inform them of claims trends or possible design problems and suggestions indicated by the trends
- If assigned to other than Extended Warranty Claims, supports the cargo expediting process for Caterpillar Inc. This process involves the receipt and disposition as a result of any notice of transit damage for Caterpillar goods via ocean, rail or truck from anywhere in the world where coverage applies to goods in transit.
- Updates and documents claim procedures and monitoring system with reporting capability by product line. Analyzes claims data to reduce or minimize claims. Audits and monitors claim handling performance of any Cat Insurance vendors or Third Party Administrators (TPAs) and stays abreast of claim details on significant claims. Directs the activity of claim analyst or adjusters as needed and adheres to all NAIC guidelines, Common goals agreements, and the Unfair Claim Practices Acts
- Works with actuarial staff to keep them informed of trends and is involved in setting pricing and reserves based upon claims trends
- Works with resources and industry contacts to stay abreast of current claims trends, technology and resources. Helps dealers achieve above average claims service and educates dealers, CISC staff, and vendors on claims goals, loss control initiatives and supporting metrics
- Ensures the development of timely and meaningful claims reports
- Works with Accounting to process and pay the third party legal expenses and allocated loss expense for Caterpillar Inc
- Works with Cat Insurance Business Systems to develop claims data interface and management processes
- Provides support to Caterpillar Dealers who elect to place their business insurance with CISC. This process involves, but is not limited to, reporting claims, resolving any problems, monitoring the performance of the selected insurance carriers, monitoring the performance of the programs, providing loss runs, and filing reviews and audits
- Responds to inquiries and complaints from insurance carriers, customers, dealers, brokers, and CISC management
- Participates in accomplishment of continuous improvement objectives for the department. Progress toward accomplishment of these is measured through maintenance of necessary measurements and analysis of associated data. Participates in the identification of problem areas and development of resolutions to address them
- Advanced in depth knowledge of property and casualty insurance terminology
- Demonstrated knowledge of and ability to apply documentation and flowcharting techniques to be used for claims procedures
- Working knowledge of the functional area procedures and operations related to Caterpillar’s engine and machine businesses including PSP and PIP (is assigned to ESC)
- Working knowledge of ESC products, policies, and procedures including understanding and ability to read Customized Coverage Codes (if assigned to ESC)
- General knowledge of the Cat Inc. warranty related systems for registration, claims and quality & reliability (is assigned to ESC)
- Proven ability to provide timely and accurate claims processing, reporting and loss prevention
- Demonstrated ability to identify claims trends
- Demonstrated knowledge and the ability to establish documentation, processes, and controls that support compliance with Sarbanes Oxley
- Advanced knowledge of and the ability to apply statutory regulations and the Unfair Claim Practices Acts
- Demonstrated knowledge of and ability to understand property and casualty policy forms and coverage descriptions
- Demonstrated ability to audit and monitor claims performance of vendors, dealers, adjusters, and warranty analysts
- Demonstrated knowledge of the Caterpillar dealer organization
- Advanced knowledge of and the ability to recommend and implement claims policies and procedures
- Knowledge of Caterpillar Inc. and CFSC operations
- Advanced ability to apply effective oral, written and listening communication skills with dealers, customers, company personnel, and the financial and legal communities
- Demonstrated ability to apply human relations skills
- Advanced ability to apply teamwork and cooperation skills with CFSC/CISC and outsourced companies’ employees in order to accomplish given tasks
- Advanced ability to work independently
- Must be able to utilize a keyboard for 75% of the workday and use Microsoft software
- Proven organization skills and the demonstrated ability to recognize and manage priorities
- Advanced ability to provide high level of customer service support
84
Junior Claims Analyst Resume Examples & Samples
- Terminate policy before setting up the claims process
- Process death benefits based on the policy provisions, complete requirements, validity of claims and disbursement of claims benefits
- End-to-end process- validation of claims, computation of death benefit value, check preparation
- Assess survivor ship death notices, update required systems and make payments for policy riders
- Update applicable systems with payment details made on the claim request
- Generate hard copy communications regarding status of client requests and create diary reports
- Follow-up outstanding death claims requirements after the report of a death in a timely manner
- Meet and maintain productivity, accuracy and service level standards and deadlines on the above-mentioned transactions
- Maintain and update work inventories, time trackers and other reporting documents pertinent to the process
- College/University graduate preferably with previous related work experience in the financial services
- Booting and shutting down computer, using mouse and keyboard (keyboarding)
- Knowledge of search engine, browsers, and relevant computer applications
- Minimum keyboarding skills of 30 words per minute
- Keyboarding skills
- Paragraph: 40 wpm
- Successful completion of the compliance training
- Successful completion of the eight week training program
- Manages and uses the work and production tracker accordingly
- Ability to use email
- Proficient in using all In-Force administration systems
- Knowledge of Claims and Titles functions
- Able to identify the complex and non-complex transactions
- Knowledge of insurance beneficiaries
- Knowledge of company plans, riders and benefits including sound knowledge of insurance contract language
- Mainframes
- Bridger
- BOSS
- E Treasury
85
Claims Analyst Resume Examples & Samples
- Good oral and written communication skills with a demonstrated ability to interact effectively with individuals at many levels in the organization and external business contacts. Good voice quality that is both conversational and professional
- Ability to project a positive image on behalf of the organization
- Ability to interpret and follow oral and written instructions, policies, guidelines, and processing standards
- Must be detail-oriented with good organizational skills. Ability to manage time effectively
- Ability to calculate figures and amounts such as discounts, interest, commissions, and percentages
86
Risk & Claims Analyst Resume Examples & Samples
- Provide claim oversight to the company's contract claims adjusters in order to minimize claim cost
- Work closely with outside counsel and TPA to negotiate claim settlements and set appropriate reserves on files
- Attend mediations/trials on the company's behalf
- Ensure accurate and timely claim reporting
- Organize and lead semi-annual claim reviews with claims administrator
- Design and implement supporting claim services to minimize claim cost
- Design and distribute management reports, identifying trends and assisting field operations to take necessary steps to reduce losses
- Assist managers and internal department heads with ad-hoc insurance/claim requests
- Track all financial loss data and develop benchmarking statistics to be used in assessing policy limits and deductibles
- Participate in market visits, ensuring all company and OSHA requirements are being met
- Assist with the annual and semi-annual motor vehicle records (MVR) review process
- Ensure safety training compliance with our driver training, power equipment and MSDS training
- Collect underwriting data necessary for the annual insurance renewal process
- Special projects requested by management
87
Claims Analyst Resume Examples & Samples
- Administers worker's compensation, general liability, property, automobile and various other lines of insurance claims including
- Bachelors Degree in Business Administration or related field, required
- Fully developed communication, organizational, analytical and computer application skills
88
Senior Stop Loss Claims Analyst Resume Examples & Samples
- This position displays effective communication skills while performing the following functions
- Providing counseling to clients and assisting with client service programs
- Interaction with internal departments (Underwriting, Managed Care, Accounting etc)
- Claims Analysis
- Process daily incoming Stop Loss claims
- Monitor, review and analyze various potential claims with emphasis on controlling losses through effective managed care
- Frequent overnight travel nationally to assist Manager with performing client performance evaluations to assess the accuracy of client reports submitted to HM Insurance Group, efficiency of claim operations, and adequacy of systems and procedures
- Evaluate various claims submitted by TPAs on behalf of self-funded clients for compliance with the following
- Ability to communicate concise accurate information effectively
- Problem Solving and analytical skills
89
Claims Analyst Resume Examples & Samples
- Track all inquiries in CP (online correspondence tracking system) by appropriate category
- Adhere to all established policies and procedures
- Review and resolve benefit-related discrepancies
- Request Trust-required information from participant and/or provider as appropriate
- Reconcile claim totals accurately and thoroughly, and apply appropriate benefits
- Meet minimum weekly production standards as established by Claims Manager
- Resolve personal daily aging and error reports
- Resolve and handle daily mail
- Answer department phone calls in a timely manner; research each call and seek assistance from Claims Manager as needed
- Demonstrate excellent internal and external customer service skills
- Demonstrate strong working knowledge of coordination of benefits (including Medicare)
90
Claims Analyst Resume Examples & Samples
- Reviews medical billings for the reasonableness of tests, procedures and hospital stays
- Refers medical claims for further investigation when more information is necessary or when claims are not medically reasonable
- Identifies inaccuracies of paid claims and works with third-party billers to resolve claims paid in error
- Stays up-to-date on PACE Health Plan Operations and Medicare Part D changes through HPMS notifications and the national PACE Association Part D Conference calls
- Acts as liaison between the insurance carriers and insurance broker to maintain loss expenses reserves that are reflective of the company’s exposure
- Minimum three years' experience in claims, claims adjusting or billing experience preferred
- Computer skills including knowledge of Microsoft Word, PowerPoint, Excel required. Microsoft Access preferred
- Familiarity with ICD-9/10-CM and CPT coding
- Experience with Medicare reimbursement rules and systems
- Ability to read, analyze, and interpret general business periodicals, technical procedures, or governmental regulations
- Candidates should also possess the ability to work as part of a team
91
Claims Analyst Resume Examples & Samples
- Submit and monitor reimbursement requests to GSE Investors (FNMA, FHLMC and HUD/VA) for advances incurred on defaulted mortgage loans
- Submit and monitor reimbursement request to Mortgage Insurance companies for losses incurred on defaulted loans
- Perform Loss analysis reconciliations on defaulted loans post claims to identify and report accountability and root cause for unreimbursed advances on foreclosures, DIL's and Short Sales
- Reviews payment histories and reconciles loans
- Verify claim proceeds, short sale proceeds, and 3rd party foreclosure sale proceeds are accurately credited, write-off/charge-off approval obtained and processed, if applicable, all system balances are zero, and loan removal is process in MSP
- Document and maintain all systems necessary for booking losses, assigning root cause and follow-up to prevent recurrence of loss types
- Comply with all state and federal laws, regulations and investor and insurer guidelines
- Responsible for keeping abreast of relevant changes to investor/insurer guidelines, industry standards and client expectations. In particular, must keep up-to-date on all FHA, VA, and USDA, PMI and FNMA/FHLMC servicing requirements and revisions
- Maximize the recovery of potential losses through the timely and accurate filing of mortgage insurance and investor claims. Ensure that supplemental claims are filed as needed
- Prepare monthly reports on monetary losses due to curtailments of servicing deficiencies and present to management
- Negotiate full or partial settlements with MI, Investor, or other 3rd party as required
- Provides proper application instructions once claim funds are received
- Has knowledge of all Default Servicing processes up to and including Loss Mitigation, Foreclosure, Foreclosure, Conveyance and Claims in addition to mortgage servicing state, federal and agency guidelines and timelines
- In depth knowledge of MSP, with at least (2) years recent experience working with MSP
- Strong analytical skills and decisive decision-making skills
- Ability to interact at a professional level with customers and attorneys
- Must be detail oriented and have excellent time management and organizational skills
- Ability to meet time deadlines while working under pressure
- Handles simultaneous tasks and projects in a fast paced environment. Able to work independently and in a team environment
- Good business writing and business math skills
- Strong PC skills. Must be proficient in MS Windows, MS Outlook, MS Office Suite, MS Visio and MS SharePoint
- Bachelor's Degree in Finance, Accounting or Business Administration preferred. Will consider a combination of equivalent experience and education
- Combined, 2+ years of experience working in Default Claims with direct experience in filing forward mortgage FHA/VA Claims and knowledge of FHA Repurchase and Conveyance processes
- Overall, 3+ years Mortgage Servicing or other relevant financial services industry experience
92
Claims Analyst Internship Resume Examples & Samples
- Validation of marketing and pricing claims and deductions support in accordance with established program policies and procedures
- Business partnering with cross functions including external customers, Regional Sales and Marketing, Finance and Supply Chain
- Identify improvement opportunities in claims processing and support process changes
- Assist in UAT (Oracle R12 implementation) and Cutover activities
93
Claims Analyst Resume Examples & Samples
- Handle moderately complex commercial auto claims including first and third party property damage exposures and bodily injury claims. Knowledge of accident benefit claims is an asset
- Perform detailed liability and damages investigations and conduct independent assessments of potential exposure
- Prepare timely coverage assessments, Reservation of Right letters and required denial letters
- Develop and implement the most cost effective disposition and litigation plan to ensure timely claim resolution through settlement or trial
- Maintain good rapport and close working relationship with business partners including underwriters, brokers, insureds and claims vendors
- Participate directly in negotiations including attending settlement conferences, mediations and trials
- Stay abreast of legal developments which impact the insurance industry in general as well as those which are specific to commercial auto claims
- Conform to company best practice guidelines and required reporting
94
Lead Stop Loss Claims Analyst Resume Examples & Samples
- <25% travel will be required nationally for audits and/or customer meetings.*
- Evaluates daily claims submitted by HMOs and Provider Excess clients against underlying policy provisions, industry standards, and systems requirements
- Monitor, review and analyze various potential claims with emphasis on controlling losses through effective managed care and use of our Navigator vendors Identifies claims for potential saving initiatives and/or audit prior to client reimbursement
- Evaluates claims for eligibility and coverage specific to reinsurance agreement on file for client
- Manages daily workload and back log independently and escalates issues to Director, Clinical Consultant and/or other business leaders
- Provides client service function for managed care claims including clients, broker and/or internal departments and customers (Underwriting, Medical Risk, Accounting and Management)
- Process internally vendor adjusted claims for our Provider Excess Loss line of business
- Provide support for the payment and mailing of checks and E-mails with payment documentation to all of our clients
- Some overnight travel nationally to assist Director with performing client performance evaluations to assess the accuracy of client reports submitted to RBS Re, efficiency of claim operations, and adequacy of systems and procedures
95
GAP Claims Analyst Resume Examples & Samples
- Gathers and assembles pertinent claim information by contacting lenders, auto dealers, borrowers and/or agents and ensuring the completeness and accuracy of documentation for processing
- Calculates claim proceeds in accordance with the Gap Contract coverage by analyzing and reviewing borrower’s loan history, MSRP/NADA valuations and primary carrier’s coverage documentation
- Responsible for fielding calls from customers, lienholders, and insurance companies while providing excellent customer service
- Submits claims calculations and supporting documentation to management for payment approval
- Requests additional documents to assist in the determination of a claim
- Must have a High School Diploma or equivalent
- Must have at least one (1) year of claims adjusting or related experience in the automotive field (Dealer/Lender)
- Must have excellent organizational and communication skills (verbal and written)
- Must be able to communicate professionally with customers, co-workers and management
- Must have a working knowledge of Microsoft Word and Excel
- Must be able to type 40 WPM accurately
- Must be able to use basic office equipment including a copy machine and fax
- Administers claims of numerous ancillary products that are financed when a customer purchases a vehicle; primarily Guaranteed Automobile Protection (GAP)
- Starts the claims process and is responsible for recognizing the required documentation that is sent in by a request
- Claims processing and GAP contract support
96
Professional Liability Claims Analyst Resume Examples & Samples
- Prepare and execute investigative action plans
- Negotiate fair and timely settlements
- Attend mediation and other court ordered settlement functions. Monitor trials
- Reports to a Claim Director and senior claims management
97
Post Claims Analyst Resume Examples & Samples
- Research insurance claims to identify set characteristics related to fraudulent behavior
- Logically link existing claims together based on fraud patterns and decision appropriately
- Become a SME on all client billing systems and internal claims systems
- Ensure projects are researched, documented, and completed in accordance with departmental standards
- Understand and stay up to date on all adjuster processes and procedures
- Interact with key stakeholders within Program Management
- Effectively communicate research findings to appropriate parties
- Knowledge of Asurion business processes
- Specific knowledge of Asurion verification process a plus
- Knowledge of Asurion administration and billing systems
98
Temporary Senior Casualty Claims Analyst Resume Examples & Samples
- Draft coverage position letters
- Investigate & evaluate cases
- Comply with all statutory and regulatory requirements in all applicable jurisdictions
- Obtain and reviews medical records
- Obtain and maintain all required licenses and certifications and meet all continuous training and certification requirements
- Determine extent of the client’s financial exposure with respect to claims; set case reserves for use by clients and regulatory authorities
- Revise case reserves based on developments in the course of adjusting the claim
- Handle complex litigated claims with limited input from the Unit Manager and/or AVP
- Select and manage experts including defense and coverage counsel
- Capable of proactively managing litigation
- Excellent written and verbal communication skills, a strong customer service focus
- Ability to work in a paperless claims environment
- Engage and manage coverage counsel and defense counsel
- Able to multitask
- 5 to 7 years’ experience with a strong background in Environmental Claims, the interpretation of coverage and the ability to author ROR and Declination letters
99
Senior Casualty Claims Analyst Resume Examples & Samples
- Evaluate insurance coverage based on claim report, the insurance policy and applicable statutes and case law to determine if a claim can be accepted as being within coverage
- Interviews, telephones, and/or corresponds with claimant and witnesses; obtains and reviews police hospital records, appraisals and repair estimates to evaluate injuries property damage; Reports to client as required by contractual account instructions; utilize appropriate methods of investigation according to type of coverage
- Obtain, review and evaluate medical records
- Identify key coverage, damage and liability issues and plan investigation as required in accordance with contractual obligations and prevailing professional standards
- Comply with all statutory and regulatory requirements of all applicable jurisdictions
- Obtain and keep in effect all required licenses and certifications and meet all continuing training and certification requirements
- Determine extent of the client’s financial exposure with respect to claims; set case reserves for use by clients and applicable regulatory authorities
- Revise case reserves based on developments in the course of adjusting the claims
- Be alert to insurance fraud and implement special procedures if possible fraud is detected
- Settle claims within assigned levels of authority as set forth in client account instructions
- Select and manage experts with limited input from supervisor
- Work with and provide claim-specific guidance to Field Adjuster
- Involve client in decision-making as appropriate and/or follow client-specific requirements for escalation when client decision-making and/or notification is required
- Strong customer service and client interaction skills
- Litigation management skills
- Coverage knowledge is required
- Strong Public Entity experience is needed
- Extensive knowledge of investigation management including, but not limited to, taking and using recorded statements, determining coverage and application of coverage to claims, delivering case value and negotiation and resolution of claims
- 5+ years experience in handling general liability claims
- Strong Public Entity experience is required
100
Claims Analyst Resume Examples & Samples
- Effective interpersonal and listening skills to build solid relationships inside and outside the Enterprise
- Strong personal work ethics
- Ability to get high quality work done through personal & professional proficiency using company tools, processes, and procedures
- Ability to communicate information in an accurate, clear, concise manner with an appropriate level of detail
- Ability to be a team player, collaborate, in addition to building and maintaining effective relationships for results
- Strong customer service orientation with high ability to empathize with customer
- Self-motivation and initiative
- Excellent math and calculation skills
- Committed to continuous self-development of technical and professional expertise
- Ability to embraces appropriate level of empowerment with accountability
- Microsoft Office proficient
- Strong analytical, problem solving, and conceptual abilities
- Ability to be self-directed and function with limited supervision
101
Claims Analyst Resume Examples & Samples
- Insurance follow-up on outstanding accounts
- Identifies patient liability
- Perform correspondence, including denials, appeals and updates interprets explanation of benefits
- Insurance re-bill requests or update accounts
- Advise manager of negative payment trends as related to specific clients
- Evaluate accounts for payment opportunities based on timely filing and other criteria
- Contact payer and management on how to proceed on accounts that need to be addressed
- Maintain accurate documentation and reports following established process and procedures and client specific guidelines
- Perform other insurance department duties or special projects as assigned by Management
- Basic computer skills; knowledge of Microsoft Word and Excel
- Ability to work under pressure; ability to work proficiently and efficiently in a timely manner
- Preferred experience in health care billing environment
- Familiar with major medical insurance carriers; medical terminology, some knowledge of HCPC, CPT & ICD9 codes
102
Risk Management Claims Analyst Resume Examples & Samples
- As a member of the Risk Management Department, assist the Director, Claims Management, in the documentation and administration of claims related to the company’s property, casualty, and financial/executive risk programs
- Provide guidance to business units on appropriate and timely reporting of incidents/claims
- Maintain claim files as appropriate
- Collect, compile and analyze claim data, generating administrative reports that coherently and succinctly identify loss data and trends
- Assist in the resolution of claims, working with insurance company adjusters, third party adjusters/administrators, legal counsel, brokers and corporate personnel as necessary
- Minimum of 5 years in the risk management and/or insurance claim industry with experience in the processing or administration of claims
- A knowledge of real estate operations is helpful but not required
- Ability to analyze complex problems involving varying viewpoints and to develop viable solutions
- Ability to multitask, adapt to changing developments, and communicate clearly
- Ease in working with people up and down the organization hierarchy
- A demonstrated ability to interact with senior executives
- Naturally adaptive to different audiences
- Diplomatically assertive
- Strong sense of integrity and ethics. Values entrepreneurialism. Demonstrates strong intellectual curiosity; always seeking new approaches and challenging the organization to new levels of success
103
Senior Casualty Claims Analyst Resume Examples & Samples
- Manage litigation
- Evaluate insurance coverage based on claim report, the insurance policy, applicable statutes and case law to determine if a claim can be accepted as within coverage
- Interview, telephone, and/or correspond with claimant and witnesses; obtain and review police hospital records, appraisals and repair estimates to evaluate injuries property damage; Report to client as required by contractual account instructions; varying method of investigation according to type of coverage
- Identify key issues and investigation required
- Effectuate prompt payment (with client’s funds) to claimants and service providers
- Be alert to insurance fraud and implement special procedures if fraud is suspected
- Review and analyze medical records
- Review and analyze expert’s reports
- Litigation management
- 5+ years’ experience in Commercial Lines including Commercial GL and Construction Defect claims
- Strong background in the investigation of liability and damages and will also possess a strong background in the interpretation of coverage, including the authoring of ROR's and declination letters
104
Senior Claims Analyst Resume Examples & Samples
- Processing Medicare Part D Claims
- Monitoring production workflow
- Reviewing quality of processed claims
- Manage varying priorities and lead projects
- Maintain high level of accuracy and quality ratings
105
Claims Analyst Remote Resume Examples & Samples
- 4-5 years of medical billing experience in a physician practice or hospital setting
- 2-3 years of experience analyzing medical data and a thorough understanding of medical claims coding (such as ICD, CPT, NDC, HCPCS)
- Proficiency with various analytic querying and reporting tools, in particular SQL
- Knowledge and experience with relational database systems (MySQL, MSSQL, Oracle, etc.) is preferred
- Ability to work with little supervision and collaborate with remote staff to meet deadlines
- Exceptional interpersonal, communication, and organization skills in order to pace your work with that of other team members
- Willingness and ability to train and educate peer team members
- College degree and / or coding certification preferred (RHIT, RHIA, CCS, CCS-P, CPC-H, etc.)
106
Construction Claims Analyst Resume Examples & Samples
- Develop and execute Construction Claims Service strategies and programs in the SF Bay Area
- 10-15 years of construction claims experience
- Extensive experience in Project Controls, CPM scheduling, delay analysis, productivity analysis, claims and dispute resolution
- Experience on large, complex construction projects
- Strong experience with P3 or P6
107
Claims Analyst Resume Examples & Samples
- You have a strong working knowledge of digital platforms
- You have an understanding of the analysis process for large metadata files
- You have a passion for metadata research, analysis, interpretation and drawing accurate conclusions
- You are highly organized with strong attention to detail and follow-up
- You work well in a fast-paced evolving work environment requiring strong multitasking skills, excellent time management, with ability to prioritize within the workload and meet deadlines
- You have excellent interpersonal skills, strategic thinker and brainstormed, results-oriented
- You have strong communications skills (written and verbal)
- You are a team player who thrives in an inclusive environment
- You have a Bachelor's degree plus preferably 1-2 years of claims analysis or metadata research experience
108
Group Claims Analyst Resume Examples & Samples
- BA/BS degree or equivalent work experience preferred
- Minimum of 3 years disability claim management experience preferred
- Canadian/International claims management experience required
- Exceptional customer service standards and delivery
- Ability to thrive in a fast-paced environment and meet deadlines
- Strong math and calculation skills
- Excellent interpersonal, organizational, negotiation, investigative, analytical and research skills
- Critical attention to detail
109
Claims Analyst Resume Examples & Samples
- Perform claim analysis and summarize results with detail at the individual claim level
- Perform root cause analysis and/or statistical analysis to determine underlying causes of errors
- Gain and maintain proficiency in TRICARE policy, claims systems, and adjudication rules. Stay abreast of changes
- High school graduate
- Knowledge of health care or insurance industry for those non-degreed applicants
- Strong communication and research skills
- Personal computer literacy with spreadsheet, word processing database capabilities (Microsoft Office Suite; specific concentration with Access, Excel, and PowerPoint)
- Familiarity with SharePoint capability as a resource and as a dataset
- Ability to gather accurate information from a data warehouse or other relational database environment
- Familiarity with TRICARE Policy and claim adjudication systems
110
Claims Analyst Resume Examples & Samples
- Works cross-functionally with other key departments to identify and implement process improvement opportunities
- Understand and interpret customer business requirements, benefit structures, and payment policies, including Medical Coverage Guidelines, to drive configuration within CCX platforms
- Aide with the integration of business rules into CCX platforms using clear communication, adherence to policies, procedures and regulations while maintaining regulatory compliance and industry standard practices
- Strong analytical and problem solving skills, including experience with medical claims processing
- Participate in testing efforts as necessary between cross-functional areas to accurately promote CCX system enhancements
- Aide in the research, documentation, and testing of CCX systems for the implementation of new business or software
- Aide in data analysis of various platforms, documentation and testing, and assist in CCX projects from initial scoping through final delivery and sign-off
- Aide in maintenance of business rules repository by actively monitoring and participating in IT meetings, understanding and documenting changes to CCX platforms
- Associates degree in Health Information, Healthcare Administration, or the equivalent; or a minimum of 5 years of equivalent Healthcare experience
- Previous experience in configuration at a Health Plan company
- Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills
- Must be able to manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking
- Must be able to work independently as well as part of a team in a fast-paced environment
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Public Entity Claims Analyst Resume Examples & Samples
- Analyze Coverage
- Evaluate exposure and set appropriate reserves
- Direct and manage defense and coverage counsel and insure they work within scope and litigation budget
- 10 years in P&C claims and at least 5 years’ experience with complex litigation claims handling
- Superior writing skills for communications of claim exposure to the company’s senior management
- Experience using paperless automated claim systems along with Micro Soft products
- B.S or B.A. from an accredited college or university. Advanced degrees, industries designations (CPCU, AIC, etc.) or J.D. is a preferred
- The ability to travel domestically
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Claims Analyst Resume Examples & Samples
- Collect and analyze numeric data from various sources and format the data into KPI/KPO’s for use in monthly metric reviews
- Generate recurring charts and analyze the data
- Develop and maintain trend charts that display trends over time
- Utilize IT skills to setup automated data fields in common sharepoint databases
- Generate complex statistical analysis for use in common sharepoint databases
- Analyze data for accuracy and integrity on a daily basis
- Develop conclusions based on data analysis and make recommendations to management
- Monitor and report KPI/KPO’s to management on developed frequencies
- Maintain/champion the Novi Auto Sharepoint. (shared database)
- Bachelor’s degree in Business Data Analytics, Industrial Engineering, Business, or other analytical field
- Prefer 1-2 years of experience in claims, prefer one to five years’ experience or internship/Co-op
- Understanding of data analysis packages such as MiniTab.or other statistical analysis system, data mining and text analytics software
- Excellent communication (oral and written) skills; ability to communicate, lead, and drive performance and change with all levels in the organization
- Desire to take initiative and develop a pro-active relationship with internal and external customers and suppliers
- Proven record of success and expanded responsibility within a growing and complex organization
- Matrix organization experience
- SAP Experience, Share Point Experience
- Strong analytical skills with advanced proficiency in Excel
- Strong understanding of relational database design and query tools
- Ability to perform work accurately and independently
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Claims Analyst Resume Examples & Samples
- Input Notice of Loss setup (NOLS)
- Handle incoming calls and route to the appropriate party
- Take new losses by phone
- Open mail, scan and attach to Claims Assure
- Photocopy as requested
- Process invoices to ensure timely payment
- Assign appraisals upon request
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Claims Analyst Resume Examples & Samples
- Monitor and review submitted incidents for accuracy and integrity, ensuring all incident fields have been properly entered and are distributed to communities and stakeholders
- Work with associates at each community to ensure a prompt response and resolution of each incident. Complete a thorough investigation for all incidents. Provide advice and guidance to communities to resolve all risk management related issues
- Investigate claims by collecting pictures, statements, contracts, leases, etc. to provide a complete record to claims adjuster for review and resolution
- Gather information for discovery requests including: reviewing insurance policies, property ownership information and historical incident reports
- Serve as system owner and relationship manager for the risk management information system. Ensure system data integrity, import data as needed, verify accuracy of data, and run ad hoc reports from the risk management system. Troubleshoot all system issues, make changes to forms and code tables, perform data updates and work with the vendor to implement new features
- Investigate and settle in-house claims with designated authority by negotiating with attorneys, insurance companies and other third parties
- Provide oversight and direction to third party claim administrators and outside counsel for assigned claims. Manage and settle assigned claims within designated authority
- Investigate, gather Invoices and other documentation to send subrogation demands to insurers and other responsible parties for assigned property claims
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Claims Analyst Resume Examples & Samples
- Must have a full understanding of claim adjudication for First & Third Party, Med Pay, No-Fault, Group Health, Workers Compensation, hospital claims and PPO
- Must have full understanding of the various types of medical billings and ability to identify which system database should be used
- Must be able to cross reference different types of billings to ensure consistency in the review process
- Must possess knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD-9 coding, bundling/unbundling and duplicate billing
- Must possess complete knowledge of general computer, fax, copier, scanner, and telephone
- Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet
- Must have a full understanding of HIPPA regulations and compliance
- Must be a qualified typist with a minimum of 35 W.P.M
- Ability to follow instructions and respond to managements’ directions accurately
- Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met
- Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed
- Must be able to work independently, prioritize work activities and use time efficiently
- Must be able to demonstrate and promote a positive team -oriented environment
- Must be able to stay focused and concentrate under normal or heavy distractions
- Must be able to work well under pressure and or stressful conditions
- Must possess the ability to manage change, delays, or unexpected events appropriately
- Demonstrates reliability and abides by the company attendance policy
- Must maintain a professional and clean appearance at all times consistent with company standards
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Salvage Claims Analyst Resume Examples & Samples
- Handle initial set up of Salvage claim file and determine plan of action to perfect recovery. Control costs. Investigate and maintain a complete and thoroughly documented claim file
- Treat customers in a courteous, friendly and professional manner. Provide timely, thorough, accurate information and assistance
- Conduct timely follow up and evaluate if changes in plan of action is necessary
- Maintain regulatory compliance with state salvage requirements
- Handle high profile files that may involve interacting with management, legal counsel, or other legal entities
- 3 + years in insurance industry is needed with a background in salvage preferred
- Skilled technician in a hands-on environment, often highly specialized
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Claims Analyst Resume Examples & Samples
- Three to four years of related experience (Claims, Financial analysis/Accounting)
- Thorough knowledge of financial analysis techniques and general accounting procedures
- Well-developed mathematical and analytical skills
- Advanced knowledge of financial analysis, forecasting, and planning
- Expert ability to identify and resolve exceptions and to interpret data
118
Claims Analyst Resume Examples & Samples
- Handle commercial auto claims including first and third party property damage claims, including total losses
- Prepare timely coverage assessments and appropriate correspondence including reservation of rights and denial letters
- Perform detailed investigation and conduct an independent assessment as to potential exposure
- Develop and implement the most cost effective disposition plan to ensure timely claim resolution through settlement
- Maintain good rapport and close working relationship with business partners including customers, underwriters, brokers and vendors
- Participate directly in negotiations when required
- Stay updated on legal developments which impact the insurance industry in general as well as those which are specific to commercial auto claims
- Follow company best practice guidelines and required reporting requirements
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Claims Analyst Resume Examples & Samples
- Provide superior customer service to clients
- Analyze quarterly survey responses, determining billing codes and compliance
- Communicate with software developers to improve existing functionality and resolve issue
- Internal product management
- Participate in and support project development and planning
- Support special projects
- Strong analytical skills, including the ability to recognize trends, determine first and second order effects, identify incongruences, and present data in a format that drives decision making
- Excellent ability to build and maintain business relationship with clients by providing professional and accurate service
- Excellent organizational, oral presentation, and written communication skills
- Proficiency in MS Office products, including Outlook, PowerPoint, Excel and Word
- Ability to learn and retain new technology quickly
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Claims Analyst Resume Examples & Samples
- Develop a solid understanding of assigned client’s process in order to strategically review and analyze their A/R functions
- Conduct regular audits of Medical Billing Specialist claim work for accuracy and quality; manages clean claim ratios for assigned clients
- Provide direction to Client Leads on claim audit corrections and resolution
- Prepare and analyze reports of audit reviews and performance issues with a focus on identifying trends, instituting continuous quality improvement initiatives, and identifying and providing on-going training opportunities for specialists
- Provide second-tier review on advanced and escalated claim issues to a satisfactory resolution
- Resolves outsource vendor’s escalates claims and claim rework
- Log all client issues encountered in internal tracking system, including enhancement requests, bugs, errors, and inquiries. Make management aware of any client issues or problems
- Modifies process and procedures to prevent claim rework through automation ideas
- Participate in continuing education of applicable software and hardware
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Internal Mortgage Claims Analyst Resume Examples & Samples
- Familiarity with VA, FHA and USDA servicing guidelines
- Solid understanding of
- College degree preferred in Business, Math, English, Legal or other related subject (and/or equivalent work experience)
- Knowledge of mortgage banking, familiarity with RESPA, FDCPA, GLBA, and federal and state laws related to foreclosure and bankruptcy processes
- 2-4 years of experience preferably is a mortgage banking environment learning all the rules and regulations
- Ability to audit and analyze work outputs by interpreting government agency and department guidelines/standards
- Advanced analytical skills, ability to analyze problems and provide the appropriate solution
- Advanced problem solving, multi-tasking and organizational skills with strong attention to detail
- Ability to analyze data and make recommendations on how to improve trends
- Must be highly confidential to protect the client's privacy rights
- PC skills including (but not limited to) advanced Word, Excel, Access, Internet, MSP (LPS/Fidelity) application skills
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Internal Mortgage Claims Analyst Resume Examples & Samples
- FHA Part A and B Claim Filing
- FHA Supplemental Claim Filing
- FHA Loss Mitigation Claim Filing
- VA Claim Filing
- USDA Claim Filing
- Track claim findings and respond to LoanCare leadership team
- Review all past claims filed to determine possible recoverability, report on identifiable recoverable losses & document steps to assist with loss recovery
- Integrate specific servicing requirements regarding loss analysis processes
- Expedite claims processing and share feedback with processors/staff
- Provide flexible, scalable claims management solutions
- Comply with all state and federal laws, regulations, investor and insurer guidelines
- Responsible for keeping abreast of relevant changes to investor/insurer guidelines, industry standards and client expectations
- Reconciliation goal is to maximize the recovery of losses through the timely and accurate filing of mortgage insurance and investor claims
- Identifying gaps in the department policies and procedures which allowed breakdown and provide recommendations to correct breakdown in process
- Field questions about the file from management as well as present complete file case review to management with recommendations for improvement
- Excellent professional verbal and written communications skills
- Ability to meet strict deadlines and take direction from more senior personnel
- Previous Default servicing experience preferred
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Claims Analyst Resume Examples & Samples
- Provides high quality customer service by determining the best approach for handling issues
- Conduct claim audits of adjusters' work product and monitor accuracy of loss data
- Responsible for analyzing any claims assigned in accordance with the department's claim handling guidelines
- Responsible for the appropriate documentation of all analytical and evaluative processes and communication interfaces with respect to the determination of coverage, the investigation and assessment of liability and damages exposures, settlement within established authority and reinsurance reporting
- Provide appropriate input and direction to loss adjustment resources (independent adjusters, claims adjusters, etc.) and legal resources (defense attorneys, etc.)
- Maintain and document accurate loss data and the basis for reserve changes and recommended reserve changes
- Focus on quality work and job performance
- In addition to other lines, knowledgeable of liability and worker's compensation claims processes and best practices
- Must be able to multi-task, be well organized and detail oriented
- Must be proficient working with database and processing software, Excel, Word and Outlook
- Must be able to successfully complete licensing and claims certification schools/classes, where required
- Phone
- Pen and paper
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Claims Analyst Resume Examples & Samples
- Clear data and claim exceptions and ensure deficiencies are flagged correctly
- Analyze claims as a whole along with supporting documentation to ensure eligibility determination is reasonable and correct
- Send deficiency and rejection letters and process claimant responses
- Identify and correct beneficial owner errors
- Identify and clear basic duplicate claims
- Identify and process shorts and transfer transactions
- Other duties or tasks as assigned by management
- Intermediate knowledge of standard Microsoft software; WORD, OUTLOOK & EXCEL
- Typing 40 WPM
- Working knowledge of financial products (e.g. stocks, bonds & options)
125
Warranty Claims Analyst Resume Examples & Samples
- Analyze and process warranty claims
- Review claim information provided by dealers and, working independently or with Supplier Recovery, Engineering, Field Service, or Customer Service process claims per established guidelines
- Manage accurate invoicing and reconciliation of all Supplier Recovery related warranty costs
- Travel to Fleet/Dealer/Production locations as needed (<5% travel required)
- A.A. required or a minimum of 3 years of PACCAR, or related, experience required; BS/BA preferred
- 2+ years related experience required. Experience can be substituted with degree
126
Group Claims Analyst Resume Examples & Samples
- Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
- Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
- Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
- Pays all covered claims accurately and timely
- Executes on all customer performance guarantees
- Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
- Ability to handle potentially high levels of call volume from customers and clients
- Exhibits claim management performance according to quality and compliance standards
- Manages both new claims and open claims equally and maintains decision times
- Adheres to standard timeframes for processing mail, tasks and outliers
- Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
- Demonstrates focus on team and office goals by developing an understanding of relationships with our business partners and positively interacting with business partners as needed
- Understands Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
- Stays abreast of ongoing trainings associated with role and business unit objectives
- Mentors and coaches new hires as needed
- Ability to serve as a point person for projects and/or reporting functions
- Contributes actively to team service and quality objectives to help create a high performance and supportive work environment
- Provides assistance to Senior Claim Manager with responsibilities as needed
- Identifies issues, proposes solutions and follows through on commitments
- BA/BS degree preferred
- Minimum of 3 years disability claim management experience
- Multilingual skills are highly desired
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Claims Analyst Resume Examples & Samples
- A minimum of 1 year of experience in a Customer Service Claims environment
- Excellent customer service skills with the ability to diffuse difficult customer challenges and possess excellent problem solving skills
- Customer-centric approach to problem resolution
- Must work well in a team environment, as well as independently
- Must be flexible and adapt quickly to change
- Should also have great typing skills and be familiar with 10-key
- Must be a meets in performance results
- Proficient in Excel and Word
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Claims Analyst Resume Examples & Samples
- Follows written procedures and scripts
- Uses proprietary software tools to access and review claim documents, enter claim decisions, and create escalations when needed
- Communicates immediately to leadership all obstacles to completing work
- Meets and exceeds departmental expectations for accuracy and productivity
- Utilizes documented team processes to ensure compliance with departmental standards
- Data entry and verification
- Supports Claims Analysts 1 (CA1) with processing questions and escalations
- Analyzes escalation content to resolve and routes as appropriate
- Reviews and distributes reports on work assignments, escalations, and/or QA results
- Drafts claimant facing communications based on guidance provided
- Verifies data and processing requirements and makes corrections as necessary
- GED or High School Diploma
- Strong written English language skills
- Ability to sit at a computer workstation for long periods of time
- Demonstrated skill in analyzing data
- Demonstrated success in a CA1 role
129
Senior Claims Analyst Resume Examples & Samples
- Develop and execute Construction Claims Service strategies and programs in the NYC Metro
- Lead a team in the analysis or preparation of a complex construction claims, being responsible for the deliverable to the client, whether it be a report, presentation or expert testimony
- Interface effectively with clients, coworkers, and others
- 7-10 years of construction claims experience
- Heavy Highway or Building construction experience
130
Senior Claims Analyst Resume Examples & Samples
- Qualification in Construction Law, Engineering or Quantity Surveying is a prerequisite and any further qualifications in Arbitration are desirable
- The individual must have extensive international field based experience (preferably in the Middle East) on large Infrastructure and Aviation Projects and be able to confidently determine the requirements in order to prepare and present large value Extensions of Time claim
- The individual must be fully conversant in planning all aspects of a large value claim including the timescales and resources required and the cost implications, and be proficient in drawing up a detailed plan
- The individual must be an effective communicator in both written and oral forms and be able to produce technical papers/material and confidently report and present these to external consultants and senior managers. He/she must be able to prepare Statement of Claims, reply to Respondents and provide consultancy for preparing experts’ reports and witness statements
- The individual must have very significant relevant experience in hands-on planning of large international Construction Projects as well as particular experience in forensic delay analysis, preparing Extension of Time Claims for the relief of Liquidated Damages
- The individual must be fully conversant with P6 with substantial Primavera related experience preferably up to expert level. He/she must have expertise on disruption/and productivity analysis using methods such as As-Planned/As Built and Impacted as Planned
- The individual must have experience of working with Arbitration teams and external consultants on Extension of Time and Quantum Claims with FIDIC contracts together with detailed knowledge of Pickavance/SCL/AACE Protocols and be able to demonstrate competent use of concepts such as concurrent and parallel delays, excusable/non-excusable compensable/non-compensable case law and reference text
131
Claims Analyst Resume Examples & Samples
- Minimum of 3 to 5 years of experience in the handling of professional liability claims
- Knowledge of construction industry
- Proficient computer skills
- Excellent communication skills (both written and oral) to effectively and professionally interact with brokers, insureds, counsel and other industry professionals
- Multi-state adjuster licenses and/or JD preferred
- Claims and/or litigation background
- Bachelor's Degree (or equivalent) required; Juris Doctor (JD) preferred
132
Claims Analyst Resume Examples & Samples
- Knowledge of CPT, HCPCS, AND ICD-10 codes and understanding of medical terminology
- 4 years of experience in a healthcare environment
- Demonstrated ability using all Microsoft applications, including strong keyboard and navigation skills, and capability to learn new programs
- Ability to multitask which includes understanding multiple insurance products and multiple levels of benefit within each product
- Ability to work independently and demonstrate good judgment
- Demonstrated ability to collaborate with internal and external teams external partners, and other stakeholders
- Creative problem solver with demonstrated ability to provide pragmatic legal solutions to complex business problem
- Knowledge of the fertility industry
133
Medicaid Claims Analyst Resume Examples & Samples
- The Medicaid Claims Analyst II will assist Specialists with quarterly state invoices. Able to identify invoices discrepancies and communicate proposed unit and rebate amounts to states. Support and/or give recommendation to Specialists to apply correction to invoices. Able to work independently and give recommendations to issues related to disputed claims. Work closely with Sr. Medicaid Manager and/or Finance to communicate accrual accounts where significant rebates impact quarterly accruals. Work with Brand Teams to resolve issues related to accrual forecast. Able to identify and provide feedback to brand team when needed
- Prepare & analyze claim level detail utilizing Validata for brand/generic products for assigned states and ensure all analysis is completed within 30 days from receipt of invoices. Review Revitas variances test results and make determination of findings; work with state to address discrepancies and provide recommendation and/or propose resolution
- Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims. Ability to work independently and make recommendation on state disputes and apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings
- Review, Approve and Settle all claims to $100K. Ability to work with minimal supervision and make recommendation to outstanding Medicaid claims amounts
- Ensure all Validata analysis Export is completed weekly for Teva brand claims. Make quality work-related decisions based on results of data
- Review of Teva Medicaid usage to determine which state formularies could be excluding a Teva NDC from its program and work to add such products to state formularies. Note: such actions will add to Teva’s sales totals via spillover measures
- Work with Sr. Manager & Govertnment Pricing team to resolve Rebate Per Unit issues & update Quarter Package Price(s) in Revitas
- Work with Sr. Manager on various projects including price reporting issues and provide ad hoc analytical and administration support with a variety of projects
- Quarterly review products based on each states formulary and compare to transactional details available utilizing preferred drug list by states; and/or other data reports to identify why states are not reporting Teva products
- HS Diploma or GED required, Bachelor’s Degree highly preferred
- 6+ years experience handling Medicaid claims or similar finance detail within a pharmaceutical company or comparable. Equivalent combination of education and experience will be considered
- Must have Intermediate to advanced knowledge of the Model N or Revitas Medicaid and/or Validata system (or other comparable system). Must have Intermediate to advanced Microsoft Excel skills
- Expereince with Validata, Oracle, SAP, Business Intelligence, Oracle Discoverer preferred
- Pharmaceutical industry experience/knowledge strongly preferred
134
Senior Claims Analyst Resume Examples & Samples
- Maintains knowledge of HUD regulations and guidelines regarding the claim procedure
- Reconciles corporate expenses to the loan transaction history
- Reviews servicing timelines to determine if the servicing was in compliance with HUD guidelines
- Self-Curtails claims if they are not in line with compliance measurements
- Verifies default monthly interest to ensure accuracy of its calculation
- Verifies taxes and hazard insurance are pro-rated accordingly
- Ensures all support documentation required for a HUD claim are included in the claim package and are sequentially placed in order according to HUD requirements
- Audits parts B-E on the 27011 form to ensure the correct dates, descriptions, paid amounts, and invoice amounts are documented / makes adjustments, if necessary
- Documents the claims database and Navigator with the status of the claim
- Ensures the transaction history is up to and including the due and payable date
- Reviews disbursement transaction histories to ensure all claimable expenses have been claimed and disallowed expenses have not been included
- Conducts a balance analysis to ensure the claimable expenses included on the Hermit worksheet are reconciled with the claimable expenses included in the Hermit upload
- Responds to HUD’s requests for additional information within established timelines
- Works with other departments to correct support documentation, when required
- Assists management with HUD audits, as necessary
- 2 years mortgage servicing experience preferred
- 4 years of mortgage loan servicing in default, foreclosure, and/or bankruptcy or 4 years of claim experience and/or accounts payable
- Ability to be a team player
- Ability to calculate basic financial figures
- Ability to research and collect data
- Working knowledge of Microsoft Outlook, Word, Excel, and Adobe Professional
135
Claims Analyst Resume Examples & Samples
- Serve as point of contact for the claims Team to delegate, prepare, and prioritize escalated indemnity issues for the Account Management, Client Benefit Administration, and Client Service Center. Responsible for claims team professional and timely responses to all inquiries. To attend strategic meetings regarding corrections to projects to correct benefit and eligibility issues
- Make independent judgments in order to respond to complex or critical customer claim related issues requiring a higher degree of expertise or discretion to resolve customer or client issues and ensure timely resolution. Involve Account Manager or Leadership team in heightened client/member issues. Analyze research and resolve requests for expedited or escalated claim issues including member submitted, pharmacy submitted, or indemnity issues. Manipulate any of the five separate applications in order to research and resolve claim issues
- Maintain accurate and complete documentation. Update all logs and Call Center tools with claim status. Maintain service levels and performance guarantees
- Identify, document and report all repetitive questions and/or problems as well as adjudication errors to identify trends and recommend potential solutions
- High school diploma or equivalent required, some college or technical training preferred
- 3-5 years experience in PBM industry or ESI claims department or equivalent work experience
- Strong data entry, 10-key skills, general PC skills and MS Office experience
- Strong
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Senior Casualty Claims Analyst Resume Examples & Samples
- Responsible for claims management (Liability and TX Non-subscriber) including oversight of the third party administrator, real-time response to claims, maintaining integrity of claim data, reviewing DriveCam, development and monitoring of the claim strategy, approval of settlements, oversight of the litigation process, monitoring vehicle legal holds
- Support the execution and oversight of the Temporary Transitional Duty Program through assistance to the field with education, job functional analysis, compliance and challenging issue resolution and guidance
- Ensure that the company’s claim reserves are adequately and timely established for financial reporting purposes and compliance with required Reserve & Settlement policy guidelines
- Responsible for maintaining DriveCam videos in support of auto claims as needed to include categorizing DriveCam utilization
- Utilize on-going review of claims and analytics to identify higher cost claim trends, partner and communicate with Safety resources to identify areas of potential improvement
- Provide education and training support to operations in the development and execution of consistent liability claim management programs
- Build, maintain and manage relationships with internal customers, third-party administrators, insurers, legal counsel and other claims related parties
- Complete claim audits, claim leakage audits and other developed processes to identify TPA improvement opportunities
- Provides assistance to field operations, EHS, Logistics, and other business units on challenging claim issues, coordinates and works with Director of Risk Management on complex issues
- Attend and/or participate in claim reviews as requested,
- Other projects or responsibilities as requested
- Bachelor’s degree with 5+ years of experience in a claims department
- Associate in Claims designation or licensed adjuster designations are preferred
- Experience in liability claims; Texas Non-subscriber a plus
- Familiarity with claims systems such as ClearSight preferred
- Flexible nature, the ability to prioritize effectively and the desire to work in a team-oriented environment
- Claims management and claim process skills
- Strong PC skills including, but not limited to, knowledge of spreadsheets
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Claims Analyst Resume Examples & Samples
- Quality control auditing and analysis experience preferred
- Medical billing knowledge and Healthcare experience preferred
- Strong analytical skills; ability to conduct research, creatively solve problems, and deal with ambiguity
- Able to read, analyze, and interpret complex documents
- Independent, logical, strategic thinker with high focus and attention to detail
- Effective written and verbal communication and presentation style
- Proficient compute skills including Microsoft Office, Word, and Excel
- Excellent interpersonal skills and able to work with a variety of personality types
- Excellent organizational skills; ability to multitask, set priorities, and meet deadlines
- Strong customer services skills and a high level of professionalism
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Claims Analyst Resume Examples & Samples
- Calculate clients’ recognized losses
- Initial analysis of trades
- Researching new claims
- Prepare new case summaries to be uploaded to claim tracking system
